Provider Demographics
NPI:1033697768
Name:STONE, JENELLE M'LOU BRAUN (MA, MS, MS, PHD -)
Entity Type:Individual
Prefix:MRS
First Name:JENELLE
Middle Name:M'LOU BRAUN
Last Name:STONE
Suffix:
Gender:F
Credentials:MA, MS, MS, PHD -
Other - Prefix:
Other - First Name:JENELLE
Other - Middle Name:M'LOU
Other - Last Name:BRAUN-MONEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MS, MS, PHD -
Mailing Address - Street 1:88701 FISHER RD.
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9392
Mailing Address - Country:US
Mailing Address - Phone:541-915-1600
Mailing Address - Fax:
Practice Address - Street 1:132 E BROADWAY
Practice Address - Street 2:STE 332
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3154
Practice Address - Country:US
Practice Address - Phone:541-915-1600
Practice Address - Fax:541-359-4433
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTSPC10501134103TS0200X
ORC4926101Y00000X, 103TC1900X
ORC6324101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling