Healthcare Provider Details

I. General information

NPI: 1902207343
Provider Name (Legal Business Name): KATIA M. SMEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 MOUNTAIN TERRACE
EUGENE OR
97408
US

IV. Provider business mailing address

2481 MOUNTAIN TER
EUGENE OR
97408-4608
US

V. Phone/Fax

Practice location:
  • Phone: 541-953-4789
  • Fax:
Mailing address:
  • Phone: 541-953-4789
  • 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:
Title or Position:
Credential:
Phone: