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NPI Code Detail

MEDICARE: LAURA JEAN ELLIBEE

MEDICARE: LAURA JEAN ELLIBEE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorOR
2101YM0800XMental Health CounselorOR

General Provider Information

NPI Number : 1104772631
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA JEAN ELLIBEE
Provider Business Mailing Address
First Line : 348 W ADAMS ST
Second Line :
City : BURNS
State : OR
Zip : 97720-1710
Country : US
Telephone Number : 541-573-8168
Fax Number :
Provider Business Practice Location Address
First Line : 348 W ADAMS ST
Second Line :
City : BURNS
State : OR
Zip : 97720-1710
Country : US
Telephone Number : 541-573-8168
Fax Number : 541-573-8168
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/10/2026

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Directions to “ LAURA JEAN ELLIBEE ” Practice Location

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