Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003108713 |
---|---|
Provider Name | Sara Jane Bellamy |
First Address | Jasper, OR 97438-9751 |
Second Address | Jasper, OR 97438-9751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 12/05/2011 |