| Doctor Name: | MRS. JEANETTE BLACK |
| NPI Number: | 1174668875 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 29821 Colvin St Gold Beach, OR - 974440746 |
| Business Phone Number: | 5412474082 |
| Business Fax Number: | 5412475058 |
| Mailing Address: | 29821 Colvin Street, GOLD BEACH |
| State: | OR |
| Postal Code: | 974440746 |
| Phone Number: | 5412474082 |
| Fax Number: | 5412475058 |
| NPI Enumeration Date: | 02/20/2007 |
| NPI Last Update Date: | 03/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |