Healthcare Provider Details

I. General information

NPI: 1013069921
Provider Name (Legal Business Name): SUSAN H. SHIPP MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 COUNTRY CLUB RD
EUGENE OR
97401-6044
US

IV. Provider business mailing address

911 COUNTRY CLUB RD STE 270
EUGENE OR
97401-6046
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-1728
  • Fax: 855-282-3544
Mailing address:
  • Phone: 541-343-1728
  • Fax: 855-282-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2826
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: