Provider Demographics
NPI:1487146049
Name:MANN, RENEE A (MS, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:A
Last Name:MANN
Suffix:
Gender:F
Credentials:MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1573
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1573
Mailing Address - Country:US
Mailing Address - Phone:541-321-0585
Mailing Address - Fax:541-391-5907
Practice Address - Street 1:315 W BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3081
Practice Address - Country:US
Practice Address - Phone:541-321-0585
Practice Address - Fax:541-391-5907
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT2406106H00000X
ORC6526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist