Provider Demographics
NPI:1417370792
Name:MOORE, JENA R (LMFT)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 COBURG RD PMB 956
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-343-7200
Mailing Address - Fax:844-364-4271
Practice Address - Street 1:240 COUNTRY CLUB RD STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2479
Practice Address - Country:US
Practice Address - Phone:541-343-7200
Practice Address - Fax:844-364-4271
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORT1610106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health