Healthcare Provider Details

I. General information

NPI: 1073668638
Provider Name (Legal Business Name): BRIAN R. W. SUNSET M.A., C.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 ARTHUR ST
EUGENE OR
97405-1522
US

IV. Provider business mailing address

PO BOX 51611
EUGENE OR
97405-0910
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-2242
  • Fax:
Mailing address:
  • Phone: 541-484-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2005-573
License Number StateNY

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: