Healthcare Provider Details

I. General information

NPI: 1013203504
Provider Name (Legal Business Name): CORTNEY MADEIRA MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORTNEY BRYANT MS

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S 73RD ST
SPRINGFIELD OR
97478-7464
US

IV. Provider business mailing address

825 S 73RD ST
SPRINGFIELD OR
97478-7464
US

V. Phone/Fax

Practice location:
  • Phone: 503-662-7170
  • Fax:
Mailing address:
  • Phone: 503-662-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC4766
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: