Provider Demographics
NPI:1902466899
Name:LABROUSSE, JENNIFER LYNNE (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:LABROUSSE
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10871 SW CANTERBURY LN STE 204
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3857
Mailing Address - Country:US
Mailing Address - Phone:503-930-6134
Mailing Address - Fax:
Practice Address - Street 1:12725 SW 66TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2547
Practice Address - Country:US
Practice Address - Phone:503-825-0234
Practice Address - Fax:503-714-3477
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health