Healthcare Provider Details

I. General information

NPI: 1295193027
Provider Name (Legal Business Name): MAXWELL SEARS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 OLIVE ST STE 304
EUGENE OR
97401-2995
US

IV. Provider business mailing address

PO BOX 50233
EUGENE OR
97405-0973
US

V. Phone/Fax

Practice location:
  • Phone: 458-240-3407
  • Fax:
Mailing address:
  • Phone: 458-240-3407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC5943
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5943
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: