MEDICARE: AMAELO EZEONWUKA 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	101YP2500X	Professional Counselor	C8404	OR
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1447650585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMAELO EZEONWUKA LPC

Provider Business Mailing Address
First Line	:	1790 W 11TH AVE
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97402-3758
Country	:	US
Telephone Number	:	541-686-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 WASHINGTON ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-4606
Country	:	US
Telephone Number	:	541-321-2278
Fax Number	:

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	09/25/2024

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