Provider Demographics
NPI:1790219962
Name:HUGHES, CLINTON (QMHA)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:HUGHES
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 BEVERLY AVE NE
Mailing Address - Street 2:BLDG G
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1319
Mailing Address - Country:US
Mailing Address - Phone:503-361-2724
Mailing Address - Fax:503-361-2782
Practice Address - Street 1:3876 BEVERLY AVE NE
Practice Address - Street 2:BLDG G
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1319
Practice Address - Country:US
Practice Address - Phone:503-361-2724
Practice Address - Fax:503-361-2782
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator