Provider Demographics
NPI:1114069192
Name:HIRT, PAIGE (MA)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:HIRT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ABERNETHY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1062
Mailing Address - Country:US
Mailing Address - Phone:503-953-5769
Mailing Address - Fax:
Practice Address - Street 1:500 ABERNETHY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1062
Practice Address - Country:US
Practice Address - Phone:503-953-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC2715101YP2500X
OR10-12-22101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)