Healthcare Provider Details

I. General information

NPI: 1609382472
Provider Name (Legal Business Name): EPIPHANY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W 34TH AVE
EUGENE OR
97405-5127
US

IV. Provider business mailing address

PO BOX 5170
EUGENE OR
97405-0170
US

V. Phone/Fax

Practice location:
  • Phone: 503-412-8868
  • Fax: 541-399-8165
Mailing address:
  • Phone: 503-412-8868
  • Fax: 541-399-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC4456
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: HEATHER LYNN GLENN
Title or Position: PRESIDENT
Credential: LPC
Phone: 503-412-8868