Provider Demographics
NPI:1760967970
Name:JESSICA KARRIKER, LLC
Entity Type:Organization
Organization Name:JESSICA KARRIKER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROF COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARRIKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-610-8391
Mailing Address - Street 1:15 NW PARK PL STE 130
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2977
Mailing Address - Country:US
Mailing Address - Phone:541-610-8391
Mailing Address - Fax:
Practice Address - Street 1:15 NW PARK PL STE 130
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2977
Practice Address - Country:US
Practice Address - Phone:541-610-8391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty