Provider Demographics
NPI:1154005239
Name:ELLERY, MEGAN ELIZABETH
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:ELLERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLERY
Other - Middle Name:JEAN
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:341 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3275
Mailing Address - Country:US
Mailing Address - Phone:541-342-8255
Mailing Address - Fax:541-342-7987
Practice Address - Street 1:341 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3275
Practice Address - Country:US
Practice Address - Phone:541-342-8255
Practice Address - Fax:541-342-7987
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health