Provider Demographics
NPI:1144833633
Name:JEREMY A. SPRINGER, LCSW
Entity type:Organization
Organization Name:JEREMY A. SPRINGER, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-861-9128
Mailing Address - Street 1:36 FOREST HILL LN
Mailing Address - Street 2:
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620-2518
Mailing Address - Country:US
Mailing Address - Phone:541-861-9128
Mailing Address - Fax:509-773-3247
Practice Address - Street 1:500 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2217
Practice Address - Country:US
Practice Address - Phone:541-861-9128
Practice Address - Fax:509-773-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500651547Medicaid