Individual
JEANETTE CERVANTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 687-1110
Mailing address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 687-1110
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11111111111
—
OR
Enumeration date
08/27/2021
Last updated
01/27/2023
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