Provider Demographics
NPI:1558980490
Name:TURNER, JEANELLE
Entity Type:Individual
Prefix:
First Name:JEANELLE
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6975 SW SANDBURG ST STE 250
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8088
Mailing Address - Country:US
Mailing Address - Phone:541-527-4422
Mailing Address - Fax:
Practice Address - Street 1:6975 SW SANDBURG ST STE 250
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8088
Practice Address - Country:US
Practice Address - Phone:547-527-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health