Basic Information
| Provider Information | |||||||||
| NPI: | 1134475437 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDANIEL | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | M. ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3995 MARCOLA RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974777948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417261465 | ||||||||
| FaxNumber: | 5417265085 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974242012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419423939 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2012 | ||||||||
| LastUpdateDate: | 01/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | T1316 | OR | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.