Healthcare Provider Details

I. General information

NPI: 1376031898
Provider Name (Legal Business Name): ELROD CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E HILLIARD LN
EUGENE OR
97404-3222
US

IV. Provider business mailing address

PO BOX 11498
EUGENE OR
97440-3698
US

V. Phone/Fax

Practice location:
  • Phone: 541-780-6842
  • Fax: 541-653-8646
Mailing address:
  • Phone: 541-780-6842
  • Fax: 541-653-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
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: MARIAN STIEGELER
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 541-780-6842