Provider Demographics
NPI:1861186470
Name:JARLEE, TRACY (OMHA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:JARLEE
Suffix:
Gender:F
Credentials:OMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 NE 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3906
Mailing Address - Country:US
Mailing Address - Phone:503-719-7985
Mailing Address - Fax:503-994-5262
Practice Address - Street 1:1817 NE 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:PORTAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3906
Practice Address - Country:US
Practice Address - Phone:503-719-7985
Practice Address - Fax:503-994-5262
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-QMHA-R-3803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health