| Doctor Name: | THERESE N MASTIN |
| NPI Number: | 1003059296 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., QMHP |
| License Number: | |
| Business Practice Address: | 410 N 9th St Cottage Grove, OR - 974241307 |
| Business Phone Number: | 5419422850 |
| Business Fax Number: | 5419421574 |
| Mailing Address: | 410 N 9th St, Po Box 5 COTTAGE GROVE |
| State: | OR |
| Postal Code: | 974241307 |
| Phone Number: | 5419422850 |
| Fax Number: | 5419421574 |
| NPI Enumeration Date: | 04/17/2009 |
| NPI Last Update Date: | 04/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |