Healthcare Provider Details

I. General information

NPI: 1295389302
Provider Name (Legal Business Name): INSIGHT NORTHWEST BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 730
EUGENE OR
97401-3160
US

IV. Provider business mailing address

132 E BROADWAY STE 730
EUGENE OR
97401-3160
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-9433
  • Fax:
Mailing address:
  • Phone: 541-357-9433
  • 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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
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: MR. JOSHUA GOTLIB
Title or Position: FOUNDER & MENTAL HEALTH THERAPIST
Credential: MS, LPC, CADC III
Phone: 541-357-9433