Provider Demographics
NPI:1497225007
Name:JELLEY, BRIANNA
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:JELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11A CANTERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-6907
Mailing Address - Country:US
Mailing Address - Phone:603-316-0523
Mailing Address - Fax:603-883-1568
Practice Address - Street 1:1 INDUSTRIAL DR STE D
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-3978
Practice Address - Country:US
Practice Address - Phone:603-316-0523
Practice Address - Fax:603-912-2092
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1543101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)