Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | C4926 | OR |
N | 101Y00000X | Counselor | C6324 | OR |
N | 103TC1900X | Counseling Psychologist | C4926 | OR |
N | 103TS0200X | School Psychologist | TSPC10501134 | OR |
NPI | 1033697768 |
---|---|
Provider Name | Mrs. Jenelle M'lou Braun Stone |
First Address | Eugene, OR 97402-9392 |
Second Address | Eugene, OR 97401-3155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2018 |
Last Update Date | 02/12/2021 |