Provider Demographics
NPI:1306320023
Name:YURGIN, MICHELE (LPC, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:YURGIN
Suffix:
Gender:F
Credentials:LPC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-1343
Mailing Address - Country:US
Mailing Address - Phone:410-440-8894
Mailing Address - Fax:
Practice Address - Street 1:206 E B ST
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-2667
Practice Address - Country:US
Practice Address - Phone:971-808-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X
WALH61102250101Y00000X
ORC6843101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500752946Medicaid