Healthcare Provider Details

I. General information

NPI: 1043196165
Provider Name (Legal Business Name): RYAN LLOYD SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 PEARL ST
EUGENE OR
97401-4010
US

IV. Provider business mailing address

2755 S M ST
SPRINGFIELD OR
97477-5262
US

V. Phone/Fax

Practice location:
  • Phone: 541-261-1969
  • Fax:
Mailing address:
  • Phone: 541-261-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: