Healthcare Provider Details

I. General information

NPI: 1235869538
Provider Name (Legal Business Name): PRANALI GARUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST STE 420
EUGENE OR
97401-8161
US

IV. Provider business mailing address

2801 KINCAID ST
EUGENE OR
97405-4155
US

V. Phone/Fax

Practice location:
  • Phone: 541-232-4268
  • Fax:
Mailing address:
  • Phone: 541-232-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22-QMHP-R-1353
License Number StateOR

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: