Healthcare Provider Details

I. General information

NPI: 1902760465
Provider Name (Legal Business Name): DUSTIN BANKS QMHP-R, CADC-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1966 GARDEN AVE
EUGENE OR
97403-1933
US

IV. Provider business mailing address

1966 GARDEN AVE
EUGENE OR
97403-1933
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-9190
  • Fax: 541-505-9264
Mailing address:
  • Phone: 541-505-9190
  • Fax: 541-505-9264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-5180
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHP-R-3592
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: