Provider Demographics
NPI:1932302833
Name:QUINN-HURST, JONATHAN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:QUINN-HURST
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2546
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0917
Mailing Address - Country:US
Mailing Address - Phone:208-263-6348
Mailing Address - Fax:
Practice Address - Street 1:1215 MICHIGAN ST-C
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-263-8948
Practice Address - Fax:208-265-1779
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW 28251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health