Individual
JEANETTE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
29413 RUSSELL ST, GOLD BEACH, OR 97444-7748
(541) 247-6566
(541) 247-6549
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
02/20/2007
Last updated
03/11/2026
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