Provider Demographics
NPI:1245793082
Name:SARGENT, MARI (QMHP)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:SARGENT
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-0736
Mailing Address - Country:US
Mailing Address - Phone:541-636-7268
Mailing Address - Fax:
Practice Address - Street 1:295 E MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1848
Practice Address - Country:US
Practice Address - Phone:541-636-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health