Provider Demographics
NPI:1285173633
Name:JESSIE, COURTNEY MONIQUE (LPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MONIQUE
Last Name:JESSIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW CIVIC DR STE 310
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3774
Mailing Address - Country:US
Mailing Address - Phone:503-666-8832
Mailing Address - Fax:
Practice Address - Street 1:1700 NW CIVIC DR STE 310
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3774
Practice Address - Country:US
Practice Address - Phone:503-666-8832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ORC8137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor