Provider Information for 1548658263
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Mr. LINCOLN TYLER WITT M.A., L.P.C.
Sex: Male
NPI: 1548658263
Last Updated: 2021-05-04
Certification Date: 2021-05-04
Certification Date: 2021-05-04
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1548658263 | ||||||||||||||||||||
| Enumeration Date | 2015-01-05 | ||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Mailing Address | 895 COUNTRY CLUB RD STE A100 EUGENE, OR 97401-6004 United States Phone: 503-740-1818 | Fax:855-476-6169 | ||||||||||||||||||||
| Primary Practice Address | 895 COUNTRY CLUB RD STE A100 EUGENE, OR 97401-6004 United States Phone: 503-740-1818 | Fax:855-476-6169 | ||||||||||||||||||||
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