Individual
MRS. JESSICA JEANNE EASTLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CMHC, LPC
Contact information
Practice address
5051 MAIN STREET, SPRINGFIELD, OR 97477-6934
(541) 357-4603
(541) 995-5013
Mailing address
PO BOX 133, VENETA, OR 97487-0133
(541) 627-8172
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C7066
OR
101YM0800X
Mental Health Counselor
R5085
OR
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C7066
OR
101YP2500X
Professional Counselor
Primary
R5085
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500796326
—
OR
Enumeration date
10/28/2014
Last updated
04/02/2026
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