Healthcare Provider Details

I. General information

NPI: 1285361246
Provider Name (Legal Business Name): OWEN MATHERLY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OWEN MATHERLY LCSW

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 8TH AVE STE 300
EUGENE OR
97401-2997
US

IV. Provider business mailing address

1225 E 38TH AVE
EUGENE OR
97405-5603
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-8168
  • Fax:
Mailing address:
  • Phone: 435-640-5649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
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: