Healthcare Provider Details

I. General information

NPI: 1497225007
Provider Name (Legal Business Name): BRIANNA JELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 04/02/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INDUSTRIAL DR STE D
HUDSON NH
03051-3978
US

IV. Provider business mailing address

11A CANTERBERRY CT
HUDSON NH
03051-6907
US

V. Phone/Fax

Practice location:
  • Phone: 603-316-0523
  • Fax: 603-912-2092
Mailing address:
  • Phone: 603-316-0523
  • Fax: 603-883-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1543
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: