Basic Information
Provider Information
NPI: 1184989857
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JEFFERIS
FirstName: ALEXA
MiddleName: DION
NamePrefix: MISS
NameSuffix:  
Credential: LMFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1179 W 5TH AVE
Address2:  
City: EUGENE
State: OR
PostalCode: 974024601
CountryCode: US
TelephoneNumber: 5417311975
FaxNumber:  
Practice Location
Address1: 1258 HIGH ST
Address2:  
City: EUGENE
State: OR
PostalCode: 97401
CountryCode: US
TelephoneNumber: 5413428437
FaxNumber: 5412422999
Other Information
ProviderEnumerationDate: 07/09/2012
LastUpdateDate: 07/03/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XT1412ORY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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