Basic Information
| Provider Information | |||||||||
| NPI: | 1649740317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUGHITT | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CADC CANDIDATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 SHELTON MCMURPHEY BLVD | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974014928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148527115 | ||||||||
| FaxNumber: | 8889750250 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 SHELTON MCMURPHEY BLVD | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148527115 | ||||||||
| FaxNumber: | 8889750250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2018 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | T-18-524 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 500754085 | 05 | OR | MEDICAID |