Healthcare Provider Details

I. General information

NPI: 1184903742
Provider Name (Legal Business Name): MAEGAN D MEXICOTTE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MAEGAN D CALVIN

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 RIVER RD
EUGENE OR
97404-3242
US

IV. Provider business mailing address

1029 RIVER RD
EUGENE OR
97404-3242
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-7585
  • Fax:
Mailing address:
  • Phone: 541-224-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5228
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500668355
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: