Provider Demographics
NPI:1639394141
Name:CHAMPION, JESSICA (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CHAMPION
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:2007-04-17
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ORT0650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)