Healthcare Provider Details

I. General information

NPI: 1215471248
Provider Name (Legal Business Name): MICHELLE RENEE WILLINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 MARTIN LUTHER KING JR BLVD
EUGENE OR
97401-5824
US

IV. Provider business mailing address

2073 OLYMPIC ST
SPRINGFIELD OR
97477-3413
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3608
  • Fax: 541-682-3276
Mailing address:
  • Phone: 541-682-3550
  • Fax: 541-682-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR
# 3
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:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: