Provider Demographics
NPI:1740726421
Name:MORAN, FIDEL MARCELO (QMHP-R-1307)
Entity type:Individual
Prefix:MR
First Name:FIDEL
Middle Name:MARCELO
Last Name:MORAN
Suffix:
Gender:M
Credentials:QMHP-R-1307
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3247
Mailing Address - Country:US
Mailing Address - Phone:541-484-4428
Mailing Address - Fax:541-484-7212
Practice Address - Street 1:260 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3247
Practice Address - Country:US
Practice Address - Phone:541-484-4428
Practice Address - Fax:541-484-7212
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YM0800X
CAASW675261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical