Provider Demographics
NPI:1689901126
Name:HURST, VICKIE KATHLEEN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:KATHLEEN
Last Name:HURST
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:KATHLEEN
Other - Last Name:HANEBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:150 RAINIER DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9507
Mailing Address - Country:US
Mailing Address - Phone:503-877-8728
Mailing Address - Fax:503-386-2453
Practice Address - Street 1:780 COMMERCIAL ST SE STE 201
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3463
Practice Address - Country:US
Practice Address - Phone:503-877-8728
Practice Address - Fax:503-386-2453
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4008101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty