Provider Demographics
NPI:1285926352
Name:RUTHERFORD, JEANETTE M (LPC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:RUTHERFORD
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 1:905 MAIN ST STE 209
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6066
Mailing Address - Country:US
Mailing Address - Phone:541-850-4747
Mailing Address - Fax:541-882-4428
Practice Address - Street 1:905 MAIN ST STE 209
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6066
Practice Address - Country:US
Practice Address - Phone:541-850-4747
Practice Address - Fax:541-882-4428
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional