Provider Demographics
NPI:1326158163
Name:MCPHERSON, SUSAN JEAN (PH D)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 WILLAGILLESPIE ROAD SUITE 202
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2104
Mailing Address - Country:US
Mailing Address - Phone:541-342-7230
Mailing Address - Fax:541-343-9801
Practice Address - Street 1:975 WILLAGILLESPIE ROAD SUITE 202
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2104
Practice Address - Country:US
Practice Address - Phone:541-342-7230
Practice Address - Fax:541-343-9801
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR593103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
J3151OtherPACIFIC SOURCE
R0000TCHPZMedicare ID - Type Unspecified