Provider Demographics
NPI:1942539929
Name:MANN, MARK J (LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:MANN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5511
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0511
Mailing Address - Country:US
Mailing Address - Phone:541-344-9334
Mailing Address - Fax:541-345-0048
Practice Address - Street 1:917 TIARA ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-6309
Practice Address - Country:US
Practice Address - Phone:541-344-9334
Practice Address - Fax:541-345-0048
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health