Healthcare Provider Details

I. General information

NPI: 1770254690
Provider Name (Legal Business Name): COLLECTIVE ELEMENTS PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E BROADWAY STE 100
EUGENE OR
97401-3338
US

IV. Provider business mailing address

440 E BROADWAY STE 100
EUGENE OR
97401-3338
US

V. Phone/Fax

Practice location:
  • Phone: 541-712-3011
  • Fax:
Mailing address:
  • Phone: 541-712-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM DUSENBERRY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential:
Phone: 541-222-9596