Provider Demographics
NPI:1992924781
Name:VANLUE, JEAN THOMPSON (MA, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:THOMPSON
Last Name:VANLUE
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 COTTAGE ST NE STE 300
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3788
Mailing Address - Country:US
Mailing Address - Phone:503-316-9130
Mailing Address - Fax:
Practice Address - Street 1:528 COTTAGE ST NE STE 300
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3788
Practice Address - Country:US
Practice Address - Phone:503-316-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2207101YP2500X
ORT0626106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional