Provider Demographics
NPI:1336872274
Name:L'ORANGE, GRACE (EDS)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:L'ORANGE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 LINWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-4713
Mailing Address - Country:US
Mailing Address - Phone:541-514-9665
Mailing Address - Fax:
Practice Address - Street 1:1855 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-4713
Practice Address - Country:US
Practice Address - Phone:541-514-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR157980103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool