Healthcare Provider Details

I. General information

NPI: 1922426436
Provider Name (Legal Business Name): SHELBY CAIN M. A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E 11TH AVE
EUGENE OR
97401-3246
US

IV. Provider business mailing address

1095 E 35TH AVE
EUGENE OR
97405-4319
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-1641
  • Fax: 541-681-3294
Mailing address:
  • Phone: 541-731-3186
  • Fax:

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: