Individual
JASON DAVID WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2901 E BURNSIDE ST, PORTLAND, OR 97214-1831
(503) 953-0310
Mailing address
3500 NE MARTIN LUTHER KING JR BLVD STE 200, PORTLAND, OR 97212-2093
(503) 655-8264
(503) 953-2454
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C7443
OR
Other
Enumeration date
02/12/2008
Last updated
04/17/2025
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