Provider Demographics
NPI:1861981862
Name:BARNER, JASON (LCPC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BARNER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20449 SW TUALATIN VALLEY HWY # 372
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-1700
Mailing Address - Country:US
Mailing Address - Phone:773-466-4640
Mailing Address - Fax:
Practice Address - Street 1:5806 N KENMORE AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-5360
Practice Address - Country:US
Practice Address - Phone:773-466-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7305101YM0800X
ILRBT-17-37937106S00000X
IL180.014239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician