Provider Demographics
NPI:1649740317
Name:HUGHITT, JESSICA LEE (CADC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:HUGHITT
Suffix:
Gender:F
Credentials:CADC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SHELTON MCMURPHEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4928
Mailing Address - Country:US
Mailing Address - Phone:414-852-7115
Mailing Address - Fax:888-975-0250
Practice Address - Street 1:10 SHELTON MCMURPHEY BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:414-852-7115
Practice Address - Fax:888-975-0250
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-18-524101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500754085Medicaid