Active NPI
Mary Therese Eagle, M.A., L.P.C.
- Professional Counselor
- Beaverton, OR
National Provider Identifier
1487808796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C1841
- Practice address
- 10700 SW Beaverton Hillsdale Hwy
Suite 525
Beaverton, OR 97005-3019 - Phone
- (503) 359-9789
- Fax
- (503) 359-0929
- NPI assigned
- Nov 13, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C1841 | OR | Primary |
Addresses
Primary practice location
10700 SW Beaverton Hillsdale Hwy
Suite 525
Beaverton, OR 97005-3019
Mailing address
3239 Circle Crest Drive
Forest Grove, OR 97116
Phone (503) 359-9789
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1841 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226534400000",
"number": "1487808796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3239 CIRCLE CREST DRIVE",
"city": "FOREST GROVE",
"state": "OR",
"postal_code": "97116",
"telephone_number": "503-359-9789",
"fax_number": "503-359-0929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10700 SW BEAVERTON HILLSDALE HWY",
"address_2": "SUITE 525",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970053019",
"telephone_number": "503-359-9789",
"fax_number": "503-359-0929"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EAGLE",
"first_name": "MARY",
"middle_name": "THERESE",
"name_prefix": "Mrs.",
"credential": "M.A., L.P.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-13",
"last_updated": "2008-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C1841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.