Provider Demographics
NPI:1730964545
Name:JEALOUS, ANNA-MARIA (MS LPC NCC)
Entity type:Individual
Prefix:
First Name:ANNA-MARIA
Middle Name:
Last Name:JEALOUS
Suffix:
Gender:F
Credentials:MS LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-1137
Mailing Address - Country:US
Mailing Address - Phone:541-301-1449
Mailing Address - Fax:
Practice Address - Street 1:149 CLEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1881
Practice Address - Country:US
Practice Address - Phone:541-301-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health