Basic Information
Provider Information
NPI: 1679943237
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AREL
FirstName: JENNIFER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1250 SE GODSEY RD APT 75
Address2:  
City: DALLAS
State: OR
PostalCode: 973382796
CountryCode: US
TelephoneNumber: 5036239289
FaxNumber:  
Practice Location
Address1: 182 SW ACADEMY ST STE 333
Address2:  
City: DALLAS
State: OR
PostalCode: 973381996
CountryCode: US
TelephoneNumber: 5036239289
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/25/2015
LastUpdateDate: 09/25/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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