Healthcare Provider Details

I. General information

NPI: 1659096782
Provider Name (Legal Business Name): MARC WILLIAM DE GIERE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 PEARL ST STE 101
EUGENE OR
97401-3570
US

IV. Provider business mailing address

1255 PEARL ST STE 101
EUGENE OR
97401-3570
US

V. Phone/Fax

Practice location:
  • Phone: 541-799-5386
  • Fax: 541-588-1150
Mailing address:
  • Phone: 541-799-5386
  • Fax: 541-588-1150

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 TaxonomyY
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: