Provider Demographics
NPI:1548658263
Name:WITT, LINCOLN TYLER (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:LINCOLN
Middle Name:TYLER
Last Name:WITT
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 COUNTRY CLUB RD STE A100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6004
Mailing Address - Country:US
Mailing Address - Phone:503-740-1818
Mailing Address - Fax:855-476-6169
Practice Address - Street 1:895 COUNTRY CLUB RD STE A100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6004
Practice Address - Country:US
Practice Address - Phone:503-740-1818
Practice Address - Fax:855-476-6169
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4452101YM0800X
ORC3843101YM0800X, 101YP2500X
NE2167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health