Provider Demographics
NPI:1043386279
Name:SHIEHAN, MARTIN RAYMOND (PHD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:RAYMOND
Last Name:SHIEHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2757 FERNDALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1870
Mailing Address - Country:US
Mailing Address - Phone:541-342-2110
Mailing Address - Fax:
Practice Address - Street 1:576 OLIVE STREET
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-284-4616
Practice Address - Fax:541-686-6283
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR037759Medicaid