Healthcare Provider Details

I. General information

NPI: 1114110087
Provider Name (Legal Business Name): DANA LYNN MORRIS PSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA LYNN BURCKEL PSS

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 CHESHIRE AVE
EUGENE OR
97402-5060
US

IV. Provider business mailing address

687 CHESHIRE AVE
EUGENE OR
97402-5060
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-2993
  • Fax: 541-343-2338
Mailing address:
  • Phone: 541-343-2993
  • Fax: 541-343-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-20-223
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier101YA0400X
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier175T00000X
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: