MEDICARE: LORI COLLEEN HAYMORE MA, NCC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C6093	OR

General Provider Information

NPI Number	:	1306374640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI COLLEEN HAYMORE MA, NCC, LPC

Provider Business Mailing Address
First Line	:	2590 PIERCE STREET
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-8200
Country	:	US
Telephone Number	:	541-953-5406
Fax Number	:

Provider Business Practice Location Address
First Line	:	2590 PIERCE STREET
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-8200
Country	:	US
Telephone Number	:	541-953-5406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	04/27/2021

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