Provider Demographics
NPI:1619585304
Name:JELLAR, COURTNEY CASH
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CASH
Last Name:JELLAR
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 1:777 HIGH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2759
Mailing Address - Country:US
Mailing Address - Phone:541-357-3248
Mailing Address - Fax:
Practice Address - Street 1:777 HIGH ST STE 240
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2759
Practice Address - Country:US
Practice Address - Phone:541-357-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-19
Last Update Date:2020-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health