Provider Demographics
NPI:1417089707
Name:MATHIS, DEBRA YVONNE
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:YVONNE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 DAVID AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-4729
Mailing Address - Country:US
Mailing Address - Phone:541-359-5012
Mailing Address - Fax:
Practice Address - Street 1:3692 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5306
Practice Address - Country:US
Practice Address - Phone:541-284-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101YM0800XOtherMENTAL HEALTH COUNSELING