Healthcare Provider Details

I. General information

NPI: 1407453079
Provider Name (Legal Business Name): ZACHARY BRENNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 CENTENNIAL PLZ
EUGENE OR
97401-2421
US

IV. Provider business mailing address

1780 FERRY ALY APT 10
EUGENE OR
97401-4652
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-6340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberB199557
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: