| Jessica Brake, Lpc, Llc | |
|
2233 W Harvard Ave Roseburg OR 97471-2550 | |
| (541) 704-8745 | |
| Not Available |
| Full Name | Jessica Brake, Lpc, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2233 W Harvard Ave, Roseburg, Oregon |
| Authorized Official Name and Position | Jessica Brake (OWNER) |
| Authorized Official Contact | 5416702264 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessica Brake, Lpc, Llc Po Box 1756 Roseburg OR 97470-0420 Ph: (541) 670-2264 | Jessica Brake, Lpc, Llc 2233 W Harvard Ave Roseburg OR 97471-2550 Ph: (541) 704-8745 |
| NPI Number | 1578287090 |
|---|---|
| Provider Enumeration Date | 09/28/2022 |
| Last Update Date | 09/28/2022 |
| Certification Date | 09/28/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578287090 | NPI | - | NPPES |
| 500663462 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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