Healthcare Provider Details

I. General information

NPI: 1033697768
Provider Name (Legal Business Name): JENELLE M'LOU BRAUN STONE MA, MS, MS, PH.D. -
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENELLE M'LOU BRAUN-MONEGAN MA, MS, MS, PH.D. -

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 332
EUGENE OR
97401-3154
US

IV. Provider business mailing address

88701 FISHER RD.
EUGENE OR
97402-9392
US

V. Phone/Fax

Practice location:
  • Phone: 541-915-1600
  • Fax: 541-359-4433
Mailing address:
  • Phone: 541-915-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberTSPC10501134
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC4926
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberC4926
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC6324
License Number StateOR

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: