Healthcare Provider Details

I. General information

NPI: 1538514021
Provider Name (Legal Business Name): ATHENA K HEDGES MFT ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 FALCON CREST DR STE 207
REDMOND OR
97756-5005
US

IV. Provider business mailing address

132 E BROADWAY STE 431
EUGENE OR
97401-3158
US

V. Phone/Fax

Practice location:
  • Phone: 541-390-4559
  • Fax:
Mailing address:
  • Phone: 541-390-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number22-QMHPC-001176
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21-QMHP-R-0512
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberR12284
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: