Healthcare Provider Details

I. General information

NPI: 1376292771
Provider Name (Legal Business Name): CASSIDY COCKLE QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E 12TH AVE
EUGENE OR
97401-3212
US

IV. Provider business mailing address

1200 HILYARD ST STE 450
EUGENE OR
97401-8164
US

V. Phone/Fax

Practice location:
  • Phone: 541-816-2793
  • Fax:
Mailing address:
  • Phone: 458-205-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHP-R-3668
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
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: