MEDICARE: MARI SARGENT QMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245793082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARI SARGENT QMHP

Provider Business Mailing Address
First Line	:	PO BOX 736
Second Line	:
City	:	TALENT
State	:	OR
Zip	:	97540-0736
Country	:	US
Telephone Number	:	541-636-7268
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 E MAIN ST STE 3
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1848
Country	:	US
Telephone Number	:	541-636-7268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	01/13/2023

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