Provider Demographics
NPI:1326568189
Name:SPURNY, GEORGE CHARLES (MAC, CADC III, ACRPS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:CHARLES
Last Name:SPURNY
Suffix:
Gender:M
Credentials:MAC, CADC III, ACRPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 INDIAN BEND RD
Mailing Address - Street 2:
Mailing Address - City:UMPQUA
Mailing Address - State:OR
Mailing Address - Zip Code:97486-9737
Mailing Address - Country:US
Mailing Address - Phone:541-912-9900
Mailing Address - Fax:
Practice Address - Street 1:2575 NW KLINE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8827
Practice Address - Country:US
Practice Address - Phone:541-673-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
508955101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
C-1311OtherCERTIFIED ADDICTION SPECIALIST
89-01--18OtherCERTIFIED ALCOHOL & DRUG COUNSELOR LEVEL III
291OtherADVANCED CERTIFIED RELAPSE PREVENTION SPECIALIST
508955OtherMASTER ADDICTION COUNSELOR