Provider Demographics
NPI:1568932390
Name:CANAGA, SHIRAH DAWN (MA, QMHP)
Entity Type:Individual
Prefix:
First Name:SHIRAH
Middle Name:DAWN
Last Name:CANAGA
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 WILLAMETTE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3170
Mailing Address - Country:US
Mailing Address - Phone:541-290-3374
Mailing Address - Fax:
Practice Address - Street 1:66 CLUB RD STE 350
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2599
Practice Address - Country:US
Practice Address - Phone:541-343-1728
Practice Address - Fax:855-282-3544
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health