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General NPI Number Information
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NPI Number | 1487808796
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Entity Type | Individual
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Provider Name | MARY THERESE EAGLE M.A., L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 10700 SW BEAVERTON HILLSDALE HWY SUITE 525
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City | BEAVERTON
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State | OR
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Zip | 97005-3019
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Country | US
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Telephone | 503-359-9789
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Fax | 503-359-0929
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Provider Business Mailing Address
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Address Line | 3239 CIRCLE CREST DRIVE
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City | FOREST GROVE
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State | OR
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Zip | 97116
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Country | US
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Telephone | 503-359-9789
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Fax | 503-359-0929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C1841
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License Number State | OR
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