Healthcare Provider Details

I. General information

NPI: 1497300198
Provider Name (Legal Business Name): ZACK ELBRIDGE HURT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 W 11TH AVE STE 200
EUGENE OR
97402-3871
US

IV. Provider business mailing address

1790 W 11TH AVE STE 200
EUGENE OR
97402-3871
US

V. Phone/Fax

Practice location:
  • Phone: 541-246-2256
  • Fax:
Mailing address:
  • Phone: 541-246-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

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: