Healthcare Provider Details

I. General information

NPI: 1972212611
Provider Name (Legal Business Name): SEEDS OF CHANGE COUNSELING SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 03/07/2024
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W 10TH AVE
EUGENE OR
97401-3008
US

IV. Provider business mailing address

PO BOX 40715
EUGENE OR
97404-0110
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-7088
  • Fax: 888-990-2234
Mailing address:
  • Phone: 541-606-5777
  • Fax: 888-990-2234

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
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:

# 1
Identifier101YM0800X
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier106H00000X
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: DAVID NEIL BOYER
Title or Position: OWNER / THERAPIST
Credential: M.ED., LMFT
Phone: 541-606-5777