Provider Demographics
NPI:1255470654
Name:ROLER HULL, MANDY ELENA (MED, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:ELENA
Last Name:ROLER HULL
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:MS
Other - First Name:MANDY
Other - Middle Name:ELENA
Other - Last Name:ROLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:399 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3380
Mailing Address - Country:US
Mailing Address - Phone:541-868-2004
Mailing Address - Fax:
Practice Address - Street 1:399 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3380
Practice Address - Country:US
Practice Address - Phone:541-868-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist