Provider Demographics
NPI:1568796712
Name:MORENO, MARLA JO (MA)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:JO
Last Name:MORENO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:MARLA
Other - Middle Name:J
Other - Last Name:STEWART-MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1973 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1934
Mailing Address - Country:US
Mailing Address - Phone:541-554-4722
Mailing Address - Fax:
Practice Address - Street 1:1973 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1934
Practice Address - Country:US
Practice Address - Phone:541-554-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC4003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health