Healthcare Provider Details

I. General information

NPI: 1598433443
Provider Name (Legal Business Name): EMERALD BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 RIVER RD
EUGENE OR
97404-3242
US

IV. Provider business mailing address

1029 RIVER RD
EUGENE OR
97404-3242
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-7585
  • Fax:
Mailing address:
  • Phone: 541-224-7585
  • Fax:

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:

VIII. Authorized Official

Name: MAEGAN D MEXICOTTE
Title or Position: OWNER
Credential: LPC
Phone: 541-224-7563