Provider Demographics
NPI:1407998263
Name:REX, JEFFREY
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:REX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61396 S HIGHWAY 97
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2157
Mailing Address - Country:US
Mailing Address - Phone:541-617-5891
Mailing Address - Fax:541-617-1144
Practice Address - Street 1:61396 S HIGHWAY 97
Practice Address - Street 2:SUITE 230
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2157
Practice Address - Country:US
Practice Address - Phone:541-617-5891
Practice Address - Fax:541-617-1144
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health