Individual
MS. JENNIFER L. MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5415 SW WESTGATE DR, PORTLAND, OR 97221-2409
(503) 645-3581
(971) 420-0297
Mailing address
1078 SE 11TH AVE, HILLSBORO, OR 97123-4796
(512) 560-9013
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
20231
TX
101YP2500X
Professional Counselor
Primary
C6625
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179075001
—
TX
Enumeration date
11/01/2006
Last updated
01/03/2024
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