Healthcare Provider Details

I. General information

NPI: 1245595479
Provider Name (Legal Business Name): JEAN DAUGHERTY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 03/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 WILLAMETTE ST SUITE 205
EUGENE OR
97401-2612
US

IV. Provider business mailing address

541 WILLAMETTE ST SUITE 205
EUGENE OR
97401-2612
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-9898
  • Fax:
Mailing address:
  • Phone: 541-485-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4685
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JEAN DAUGHERTY
Title or Position: THERAPIST/OWNER
Credential: LCSW
Phone: 541-485-9898