Provider Demographics
NPI:1700958782
Name:HARRELL, JAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 NUTLEY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2702
Mailing Address - Country:US
Mailing Address - Phone:541-482-2918
Mailing Address - Fax:
Practice Address - Street 1:219 W HERSEY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1721
Practice Address - Country:US
Practice Address - Phone:541-482-2918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCOO17101YM0800X
HIPSY 876103TC0700X
CAPSY 7029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical