Provider Demographics
NPI:1295851012
Name:HEGARTY, GERRICK TIMON (QMHA)
Entity Type:Individual
Prefix:MR
First Name:GERRICK
Middle Name:TIMON
Last Name:HEGARTY
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29428 GIMPL HILL RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9037
Mailing Address - Country:US
Mailing Address - Phone:541-302-4558
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE STE A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3780
Practice Address - Country:US
Practice Address - Phone:541-868-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health