Healthcare Provider Details

I. General information

NPI: 1295283117
Provider Name (Legal Business Name): CONCEPCION MARIN CUELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NE HIGHWAY 99W STE F
MCMINNVILLE OR
97128-2757
US

IV. Provider business mailing address

1900 NE HIGHWAY 99W STE F
MCMINNVILLE OR
97128-2757
US

V. Phone/Fax

Practice location:
  • Phone: 503-437-6510
  • Fax:
Mailing address:
  • Phone: 503-437-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5322
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: