Healthcare Provider Details

I. General information

NPI: 1104501501
Provider Name (Legal Business Name): MARY WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2581 WILLAKENZIE RD APT 6
EUGENE OR
97401-4812
US

IV. Provider business mailing address

2581 WILLAKENZIE RD APT 6
EUGENE OR
97401-4812
US

V. Phone/Fax

Practice location:
  • Phone: 805-315-1127
  • Fax:
Mailing address:
  • Phone: 805-315-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR7937
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT2816
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: