Provider Demographics
NPI:1366752974
Name:HURST, JACQUELINE L (BE, CADC II)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:HURST
Suffix:
Gender:F
Credentials:BE, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 ASTER ST APT 180
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6399
Mailing Address - Country:US
Mailing Address - Phone:541-342-8437
Mailing Address - Fax:
Practice Address - Street 1:1258 HIGH ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3238
Practice Address - Country:US
Practice Address - Phone:541-342-8437
Practice Address - Fax:541-342-1639
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health