Healthcare Provider Details

I. General information

NPI: 1164792933
Provider Name (Legal Business Name): BENJAMIN LUSKIN LPC, CPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 E 32ND AVE
EUGENE OR
97405-3759
US

IV. Provider business mailing address

476 E 32ND AVE
EUGENE OR
97405-3759
US

V. Phone/Fax

Practice location:
  • Phone: 541-999-1217
  • Fax:
Mailing address:
  • Phone: 541-999-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC5799
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
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: