Basic Information
| Provider Information | |||||||||
| NPI: | 1578764239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARLAND-MOORE | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 COMMERCIAL ST SE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973025207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0355808050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 565 UNION ST NE | ||||||||
| Address2: | #105 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973012477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033166770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.