Provider Demographics
NPI:1184159089
Name:OLIN-HARRIS, JENNIFER JAYNE (MSCPS, QMHP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JAYNE
Last Name:OLIN-HARRIS
Suffix:
Gender:F
Credentials:MSCPS, QMHP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JAYNE
Other - Last Name:OLIN-HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JENNIFER JAYNE OLIN
Mailing Address - Street 1:2577 NE COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7638
Mailing Address - Country:US
Mailing Address - Phone:541-322-7500
Mailing Address - Fax:541-322-7565
Practice Address - Street 1:1128 NW HARRIMAN ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1947
Practice Address - Country:US
Practice Address - Phone:541-322-7500
Practice Address - Fax:541-322-7565
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health