Healthcare Provider Details

I. General information

NPI: 1023550126
Provider Name (Legal Business Name): MICOLENE RENKEN THRAPP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 02/10/2024
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 823
EUGENE OR
97401-3160
US

IV. Provider business mailing address

1075 WASHINGTON ST STE 115
EUGENE OR
97401-3689
US

V. Phone/Fax

Practice location:
  • Phone: 541-799-4621
  • Fax:
Mailing address:
  • Phone: 541-799-4621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500746073
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: