Provider Demographics
NPI:1992901144
Name:SPRAGUE, MAGGIE BEATTIE (MED, LMFT, QMHP)
Entity type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:BEATTIE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MED, LMFT, QMHP
Other - Prefix:MS
Other - First Name:MAGGIE
Other - Middle Name:JANE
Other - Last Name:BEATTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:399 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3380
Mailing Address - Country:US
Mailing Address - Phone:541-868-2004
Mailing Address - Fax:541-868-2003
Practice Address - Street 1:10011 SE DIVISION ST STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1353
Practice Address - Country:US
Practice Address - Phone:503-928-3998
Practice Address - Fax:541-868-2003
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0835106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health