Provider Demographics
NPI:1205030061
Name:CUDMORE, RACHEL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:CUDMORE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4169
Mailing Address - Country:US
Mailing Address - Phone:541-335-1824
Mailing Address - Fax:541-683-3208
Practice Address - Street 1:290 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4169
Practice Address - Country:US
Practice Address - Phone:541-335-1824
Practice Address - Fax:541-683-3208
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2027101YP2500X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist