Healthcare Provider Details

I. General information

NPI: 1427698984
Provider Name (Legal Business Name): JESSE QUINN WEIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 CITY VIEW ST
EUGENE OR
97405-1582
US

IV. Provider business mailing address

1895 CITY VIEW ST
EUGENE OR
97405-1582
US

V. Phone/Fax

Practice location:
  • Phone: 303-621-5494
  • Fax:
Mailing address:
  • Phone: 303-621-5494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC7047
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016520
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: