Healthcare Provider Details

I. General information

NPI: 1124631940
Provider Name (Legal Business Name): ELIZABETH LIRA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 WILLAMETTE ST STE 201
EUGENE OR
97405-3170
US

IV. Provider business mailing address

2440 WILLAMETTE ST STE 201
EUGENE OR
97405-3170
US

V. Phone/Fax

Practice location:
  • Phone: 541-321-2278
  • Fax: 541-246-8826
Mailing address:
  • Phone: 541-321-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT1710
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1710
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500783577
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: