Provider Demographics
NPI:1023660040
Name:ZENUCH, MAHLIA MICHELLE
Entity type:Individual
Prefix:
First Name:MAHLIA
Middle Name:MICHELLE
Last Name:ZENUCH
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 1:1750 NEBRASKA AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5700
Mailing Address - Country:US
Mailing Address - Phone:541-956-4943
Mailing Address - Fax:
Practice Address - Street 1:348 RUBY AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2033
Practice Address - Country:US
Practice Address - Phone:541-956-4943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst