Provider Demographics
NPI:1801407259
Name:ANDREWS, JACQUALYN RAE (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUALYN
Middle Name:RAE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 WILLAMETTE STREET, SUITE 301, #140
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4593
Mailing Address - Country:US
Mailing Address - Phone:541-255-1411
Mailing Address - Fax:541-255-1412
Practice Address - Street 1:210 S 5TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2105
Practice Address - Country:US
Practice Address - Phone:541-255-1411
Practice Address - Fax:541-255-1412
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5956101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500787676Medicaid