Individual
JAIMES DE LEGACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PWS MH/A, CHW, CRM2,
Contact information
Practice address
10202 SE 32ND AVE STE 701, MILWAUKIE, OR 97222-3625
(541) 233-8651
Mailing address
10202 SE 32ND AVE STE 701, MILWAUKIE, OR 97222-3625
(503) 496-3201
(503) 496-3208
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
Primary
—
OR
175T00000X
Peer Specialist
—
—
Other
Enumeration date
03/01/2023
Last updated
02/18/2026
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