Most Relevant Information
Provider Data
| NPI Number: | 1003059296 |
| Provider Name: | THERESE N MASTIN M.A., QMHP |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/17/2009 |
| Last Updated: | 07/21/2022 |
Provider Practice Location
1345 BIRCH AVE
COTTAGE GROVE
OR
974241416
Practice Location Phone/Fax
| Phone: | 5419423939 |
| Fax: | 5419429310 |
Provider Mailing Location
410 N 9TH ST
PO BOX 5
COTTAGE GROVE
OR
974241307
Provider Mailing Phone/Fax
| Phone: | 5419422850 |
| Fax: | 5419421574 |