Healthcare Provider Details

I. General information

NPI: 1326242249
Provider Name (Legal Business Name): ELLYN YANDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W 12TH AVE
EUGENE OR
97401-3408
US

IV. Provider business mailing address

50 MARION LN
EUGENE OR
97404-3018
US

V. Phone/Fax

Practice location:
  • Phone: 541-214-4814
  • Fax:
Mailing address:
  • Phone: 541-214-4814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
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: