Healthcare Provider Details

I. General information

NPI: 1033455415
Provider Name (Legal Business Name): LORRAINE MCKENZIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORRAINE KERWOOD MSW

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 08/12/2022
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 HIGH ST STE 144
EUGENE OR
97401-3238
US

IV. Provider business mailing address

1292 HIGH ST STE 144
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 458-215-0179
  • Fax: 541-543-2212
Mailing address:
  • Phone: 458-215-0719
  • Fax: 541-543-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberM6689
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6689
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500689849
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: