Provider Demographics
NPI:1588098131
Name:CLEARY, KER (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:KER
Middle Name:
Last Name:CLEARY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 WILLAMETTE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2661
Mailing Address - Country:US
Mailing Address - Phone:541-349-0595
Mailing Address - Fax:
Practice Address - Street 1:474 WILLAMETTE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2661
Practice Address - Country:US
Practice Address - Phone:541-349-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional