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Organization

JESSICA BRAKE, LPC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JESSICA BRAKE LPC (OWNER)
(541) 670-2264
Entity
Organization

Contact information

Practice address
2233 W HARVARD AVE, ROSEBURG, OR 97471-2550
(541) 704-8745
Mailing address
PO BOX 1756, ROSEBURG, OR 97470-0420
(541) 670-2264

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500663462
OR
Enumeration date
09/28/2022
Last updated
09/28/2022
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