Provider Demographics
NPI:1306119813
Name:MCEWEN, GILBERT GRIFFITH (MS, LPC, NCC,)
Entity type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:GRIFFITH
Last Name:MCEWEN
Suffix:
Gender:M
Credentials:MS, LPC, NCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 CHESHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5060
Mailing Address - Country:US
Mailing Address - Phone:541-684-4100
Mailing Address - Fax:541-684-4156
Practice Address - Street 1:1651 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3363
Practice Address - Country:US
Practice Address - Phone:541-763-4557
Practice Address - Fax:541-726-2467
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC5274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663819Medicaid