Healthcare Provider Details

I. General information

NPI: 1649160698
Provider Name (Legal Business Name): ENOCH K MUDD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CENTER ST NE STE 1101
SALEM OR
97301-4532
US

IV. Provider business mailing address

3180 CENTER ST NE STE 1101
SALEM OR
97301-4532
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5352
  • Fax: 503-585-4990
Mailing address:
  • Phone: 503-569-8912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18188
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: