Provider Demographics
NPI:1427301571
Name:DEVAULT, JENNIFER (MA, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DEVAULT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2505
Mailing Address - Country:US
Mailing Address - Phone:541-686-1262
Mailing Address - Fax:541-302-0889
Practice Address - Street 1:499 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2505
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:541-302-0889
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3972101YP2500X
CO13006101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor