Basic Information
| Provider Information | |||||||||
| NPI: | 1972656346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOTLER | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | KARIN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LMFT, CADC III | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2145 CENTENNIAL PLZ | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974012474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414856340 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2145 CENTENNIAL PLZ | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974012474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414856340 | ||||||||
| FaxNumber: | 5419843124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | T0381 | OR | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | T0381 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 500693219 | 05 | OR | MEDICAID | 05071954 | 05 | OR | MEDICAID | 1972656346 | 05 | OR | MEDICAID |