Provider Demographics
NPI:1013432038
Name:SUNNYBROOK COUNSELING
Entity Type:Organization
Organization Name:SUNNYBROOK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TURGESEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-880-4738
Mailing Address - Street 1:905 MAIN ST STE 508
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6062
Mailing Address - Country:US
Mailing Address - Phone:541-880-4738
Mailing Address - Fax:541-880-4738
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:SUITE 508
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-880-4738
Practice Address - Fax:541-880-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3662101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500700790Medicaid