Basic Information
| Provider Information | |||||||||
| NPI: | 1306120589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARLE | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | CHAD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MA, MFT, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 SW RAMSEY AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419564943 | ||||||||
| FaxNumber: | 5419565463 | ||||||||
| Practice Location | |||||||||
| Address1: | 348 RUBY AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974042033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414613075 | ||||||||
| FaxNumber: | 5414611361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2011 | ||||||||
| LastUpdateDate: | 04/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C3946 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.