Provider Demographics
NPI:1023230349
Name:HURLEY, JEANNETTE L (LMFT)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:L
Last Name:HURLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 503010
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-0813
Mailing Address - Country:US
Mailing Address - Phone:541-507-6400
Mailing Address - Fax:541-479-4010
Practice Address - Street 1:777 NE 7TH ST STE 205
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1632
Practice Address - Country:US
Practice Address - Phone:541-507-6400
Practice Address - Fax:541-479-4010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1176106H00000X
CALMFT77395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT77395OtherCALIFORNIA LMFT
ORT1176OtherOREGON LMFT
CA7708OtherMEDI-CAL
CA7667OtherMEDI-CAL