Provider Demographics
NPI:1235785502
Name:JARRARD, ANTHONY DION (CADC I/CRM/PSS/QMHAI)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DION
Last Name:JARRARD
Suffix:
Gender:M
Credentials:CADC I/CRM/PSS/QMHAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4502
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:971-260-0355
Practice Address - Street 1:1631 SW COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6025
Practice Address - Country:US
Practice Address - Phone:971-261-0544
Practice Address - Fax:971-245-3043
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3210175T00000X
OR20-06-24101YA0400X
OR18-CRM-206101YA0400X
OR25-QMHA-I-005159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500768570Medicaid
OR500770905Medicaid