Healthcare Provider Details

I. General information

NPI: 1710619994
Provider Name (Legal Business Name): SHANNON MCGRATH, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 WILLAMETTE ST STE 407A
EUGENE OR
97401-2696
US

IV. Provider business mailing address

1303 BETTY LN
EUGENE OR
97404-2806
US

V. Phone/Fax

Practice location:
  • Phone: 907-230-6619
  • Fax: 541-359-4049
Mailing address:
  • Phone: 907-230-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON RACHEL MCGRATH
Title or Position: OWNER AND PROVIDER
Credential: LCSW
Phone: 907-230-6619