Provider Demographics
NPI:1689901126
Name:HURST, VICKIE KATHLEEN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:KATHLEEN
Last Name:HURST
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:KATHLEEN
Other - Last Name:HANEBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 17815
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-7815
Mailing Address - Country:US
Mailing Address - Phone:503-877-8728
Mailing Address - Fax:
Practice Address - Street 1:1675 WINTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7152
Practice Address - Country:US
Practice Address - Phone:503-877-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty