Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jason David Wallis, LPC

Individual provider Professional Counselor · NPI 1396913331

Jason David Wallis, LPC is a Mental Health Counselor in Portland, Oregon. Qualified in 2020, 6 years ago. Works from 2 locations. Licensed in Oregon.

Years since qualifying
6
Licensed in
OR
In the registry since
2008
What do these letters mean?
LPC — Licensed Professional Counselor
A licensed mental health counsellor.

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Practice location Address checks out

2901 E Burnside St
Portland, OR 97214-1831
Phone: (503) 953-0310
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3500 Ne Martin Luther King Jr Blvd Ste 200, Portland, OR 97212-2093 — (503) 496-3201

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence C7443 (OR)

Record details

NPI number1396913331
Entity typeIndividual (Type 1)
GenderMale
Credentials LPC
Sole proprietorNo
NPI enumeratedFebruary 12, 2008
Last updated in NPPESApril 17, 2025
Certification dateApril 17, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Not indicated

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