Provider Demographics
NPI:1265543169
Name:NORTH, JUEL ANN (QMHP)
Entity type:Individual
Prefix:
First Name:JUEL
Middle Name:ANN
Last Name:NORTH
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SEA WATCH PL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-8967
Mailing Address - Country:US
Mailing Address - Phone:541-997-2298
Mailing Address - Fax:
Practice Address - Street 1:1525 12TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9497
Practice Address - Country:US
Practice Address - Phone:541-902-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00000OtherNOT LICENSED