Provider Demographics
NPI:1508986605
Name:ANGELOS-MATHER, KATHERINE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:ANGELOS-MATHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2625
Mailing Address - Country:US
Mailing Address - Phone:541-484-1126
Mailing Address - Fax:
Practice Address - Street 1:1850 BAILEY HILL RD
Practice Address - Street 2:CHURCHILL HIGH SCHOOL
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1144
Practice Address - Country:US
Practice Address - Phone:541-687-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL30651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical