Healthcare Provider Details

I. General information

NPI: 1578349072
Provider Name (Legal Business Name): RENEE MANN THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W BROADWAY STE 300
EUGENE OR
97401-3081
US

IV. Provider business mailing address

PO BOX 1573
EUGENE OR
97440-1573
US

V. Phone/Fax

Practice location:
  • Phone: 541-321-0585
  • Fax: 541-391-5907
Mailing address:
  • Phone: 541-321-0585
  • Fax: 541-391-5907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional 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: RENEE MANN
Title or Position: OWNER
Credential: MS, LPC, LMFT
Phone: 541-321-0585