Healthcare Provider Details

I. General information

NPI: 1912707050
Provider Name (Legal Business Name): HEAD WELL THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E BROADWAY STE 300
EUGENE OR
97401-3352
US

IV. Provider business mailing address

440 E BROADWAY STE 300
EUGENE OR
97401-3352
US

V. Phone/Fax

Practice location:
  • Phone: 541-762-0500
  • Fax:
Mailing address:
  • Phone: 541-762-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: APRIL DVORAK
Title or Position: OWNER
Credential: PMHNP
Phone: 541-762-0500