Provider Demographics
NPI:1033230099
Name:PENN, NEIL (MFT)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:
Last Name:PENN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 CAL YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2029
Mailing Address - Country:US
Mailing Address - Phone:650-888-6118
Mailing Address - Fax:855-617-7440
Practice Address - Street 1:1472 CAL YOUNG RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2029
Practice Address - Country:US
Practice Address - Phone:650-888-6118
Practice Address - Fax:855-617-7440
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29770106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist