Individual
MIMI KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
550 RIVER RD, EUGENE, OR 97404-3212
(541) 743-2611
(541) 868-0340
Mailing address
550 RIVER RD, EUGENE, OR 97404-3212
(541) 743-2611
(541) 868-0340
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4711
OR
Other
Enumeration date
08/29/2011
Last updated
07/15/2014
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