| Doctor Name: | JESSICA LYNN NEELY |
| NPI Number: | 1376810838 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CADCI |
| License Number: | 09-P-04 |
| Business Practice Address: | 1333 Nw 9th Street Prineville, OR - 97754 |
| Business Phone Number: | 5414472631 |
| Business Fax Number: | 5414472616 |
| Mailing Address: | 1333 Nw 9th Street, PRINEVILLE |
| State: | OR |
| Postal Code: | 97754 |
| Phone Number: | 5414472631 |
| Fax Number: | 5414472616 |
| NPI Enumeration Date: | 11/28/2011 |
| NPI Last Update Date: | 11/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 09-P-04 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |