Provider Demographics
NPI:1750062683
Name:ATTMORE, JELYSSA
Entity type:Individual
Prefix:MRS
First Name:JELYSSA
Middle Name:
Last Name:ATTMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32650 STATE ROUTE 20 STE E204
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2686
Mailing Address - Country:US
Mailing Address - Phone:360-279-9000
Mailing Address - Fax:360-639-1168
Practice Address - Street 1:32650 STATE ROUTE 20
Practice Address - Street 2:E204
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2686
Practice Address - Country:US
Practice Address - Phone:360-279-9000
Practice Address - Fax:360-639-1168
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician