Healthcare Provider Details

I. General information

NPI: 1285561894
Provider Name (Legal Business Name): AUTUMN HEATHER JERNIGAN MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 SW MADISON AVE STE 230
CORVALLIS OR
97333-4924
US

IV. Provider business mailing address

257 SW MADISON AVE STE 230
CORVALLIS OR
97333-4924
US

V. Phone/Fax

Practice location:
  • Phone: 541-712-8652
  • Fax:
Mailing address:
  • Phone: 541-712-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: