Provider Demographics
NPI:1417088626
Name:HOWELL, JEREMY (LCSW)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:HOWELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CENTRAL AVE
Mailing Address - Street 2:STE. 290
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2316
Mailing Address - Country:US
Mailing Address - Phone:541-267-2113
Mailing Address - Fax:541-267-5071
Practice Address - Street 1:125 CENTRAL AVE
Practice Address - Street 2:STE. 290
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2316
Practice Address - Country:US
Practice Address - Phone:541-267-2113
Practice Address - Fax:541-267-5071
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00WCJLGAMedicare ID - Type Unspecified