Provider Demographics
NPI:1477616894
Name:ZURSTADT, BARBARA L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:ZURSTADT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15510 SW BELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9033
Mailing Address - Country:US
Mailing Address - Phone:503-625-3633
Mailing Address - Fax:
Practice Address - Street 1:15510 SW BELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9033
Practice Address - Country:US
Practice Address - Phone:503-625-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health