Healthcare Provider Details

I. General information

NPI: 1174359319
Provider Name (Legal Business Name): JORDAN BEEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 10TH AVE STE 450
EUGENE OR
97401-5599
US

IV. Provider business mailing address

360 E 10TH AVE STE 450
EUGENE OR
97401-5599
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-6983
  • Fax:
Mailing address:
  • Phone: 650-465-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: