Healthcare Provider Details

I. General information

NPI: 1497067284
Provider Name (Legal Business Name): ANDREW LEE YODER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 BIRCH AVE
COTTAGE GROVE OR
97424-1416
US

IV. Provider business mailing address

1160 W 15TH AVE APT. L1
EUGENE OR
97402-3982
US

V. Phone/Fax

Practice location:
  • Phone: 541-942-3939
  • Fax: 541-942-9310
Mailing address:
  • Phone: 541-221-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: