Provider Demographics
NPI:1427170588
Name:HURST, DAISY B (MSW, QMHP)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:B
Last Name:HURST
Suffix:
Gender:F
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-1307
Mailing Address - Country:US
Mailing Address - Phone:541-942-2850
Mailing Address - Fax:
Practice Address - Street 1:410 N 9TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1307
Practice Address - Country:US
Practice Address - Phone:541-942-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR019047Medicaid