Provider Demographics
NPI:1457663288
Name:HENDRICKSON, MARY ANGELINE (LMHC, LPC, EMMHS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANGELINE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:LMHC, LPC, EMMHS
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ANGELINE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC NCC EMMHS
Mailing Address - Street 1:399 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3380
Mailing Address - Country:US
Mailing Address - Phone:541-858-2004
Mailing Address - Fax:541-868-2003
Practice Address - Street 1:399 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3380
Practice Address - Country:US
Practice Address - Phone:541-858-2004
Practice Address - Fax:541-868-2003
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALH60376739101YM0800X
ORC4034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health