Provider Demographics
NPI:1477824779
Name:VERHOOGEN ODDEN, LISE ANNE (LPC (MS,MA))
Entity Type:Individual
Prefix:MRS
First Name:LISE
Middle Name:ANNE
Last Name:VERHOOGEN ODDEN
Suffix:
Gender:F
Credentials:LPC (MS,MA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HULT PLAZA BUILDING STE 330
Mailing Address - Street 2:401 EAST 10TH AVE.
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-868-2004
Mailing Address - Fax:541-928-3020
Practice Address - Street 1:GRANT PROFESSIONAL BUSINESS CENTER
Practice Address - Street 2:887 NW GRANT AVE.
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-714-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional