Provider Demographics
NPI:1598733230
Name:COUNTRY COUNSELING
Entity Type:Organization
Organization Name:COUNTRY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUGHEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-998-5660
Mailing Address - Street 1:230 N 3RD ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9679
Mailing Address - Country:US
Mailing Address - Phone:541-998-5660
Mailing Address - Fax:541-998-5678
Practice Address - Street 1:230 N 3RD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HARRISBURG
Practice Address - State:OR
Practice Address - Zip Code:97446-9679
Practice Address - Country:US
Practice Address - Phone:541-998-5660
Practice Address - Fax:541-998-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR989103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119293Medicare ID - Type UnspecifiedINDIVIDUAL # HUGHEY
OR119291Medicare ID - Type UnspecifiedGROUP #