Provider Demographics
NPI:1679799779
Name:GUYAN, JENNIFER J (QMHA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:GUYAN
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3957
Mailing Address - Country:US
Mailing Address - Phone:541-345-0829
Mailing Address - Fax:
Practice Address - Street 1:20 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3535
Practice Address - Country:US
Practice Address - Phone:541-654-1346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health