Provider Demographics
NPI:1326758079
Name:DR JENAE ULRICH
Entity Type:Organization
Organization Name:DR JENAE ULRICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF, OWNER, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:541-203-0984
Mailing Address - Street 1:1901 GARDEN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1934
Mailing Address - Country:US
Mailing Address - Phone:541-203-0984
Mailing Address - Fax:541-315-4835
Practice Address - Street 1:1901 GARDEN AVE STE 103
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1934
Practice Address - Country:US
Practice Address - Phone:541-203-0984
Practice Address - Fax:541-315-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty