Provider Demographics
NPI:1639687809
Name:JENNIFER WEEKS MS LPC LLC
Entity Type:Organization
Organization Name:JENNIFER WEEKS MS LPC LLC
Other - Org Name:JENNIFER WEEKS COUNSELING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-480-9443
Mailing Address - Street 1:1104 NE REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4150
Mailing Address - Country:US
Mailing Address - Phone:541-480-9443
Mailing Address - Fax:
Practice Address - Street 1:61533 PARRELL RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2701
Practice Address - Country:US
Practice Address - Phone:541-480-9443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4552261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500665864Medicaid