Healthcare Provider Details

I. General information

NPI: 1548474562
Provider Name (Legal Business Name): CHRISTIANS AS FAMILY ADVOCATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 COUNTRY CLUB RD 222
EUGENE OR
97401-2257
US

IV. Provider business mailing address

921 COUNTRY CLUB RD 222
EUGENE OR
97401-2257
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-6000
  • Fax: 541-344-8239
Mailing address:
  • Phone: 541-686-6000
  • Fax: 541-344-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500694292
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MS. CAROLYN ANN REXIUS
Title or Position: DIRECTOR
Credential: LCSW
Phone: 541-349-7550