Healthcare Provider Details

I. General information

NPI: 1508901901
Provider Name (Legal Business Name): MAUREEN ELIZABETH MACDONELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2988 OAK ST
EUGENE OR
97405-3782
US

IV. Provider business mailing address

PO BOX 23338
EUGENE OR
97402-0427
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1262
  • Fax: 541-686-0359
Mailing address:
  • Phone: 541-686-1262
  • Fax: 541-686-0359

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:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: