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Provider Information for 1619416625


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JAYE BAHRE


Sex: Female

NPI: 1619416625
Last Updated: 2017-02-23
Certification Date:

Details

NameValue
NPI1619416625
Enumeration Date2017-02-23
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 3587 HEATHROW WAY
MEDFORD, OR 97504-4004
United States

Phone: 541-858-8170 | Fax:
 
Primary Practice Address 17720 NE HALSEY ST STE B
PORTLAND, OR 97230-6771
United States

Phone: 503-654-7654 | Fax:503-654-7333
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental Health