Healthcare Provider Details

I. General information

NPI: 1912491366
Provider Name (Legal Business Name): TESS KOVACS DRAZDOWSKI PH.D., QMHP, CADCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TESS KATHERINE DRAZDOWSKI

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SHELTON MCMURPHEY BLVD
EUGENE OR
97401-4928
US

IV. Provider business mailing address

10 SHELTON MCMURPHEY BLVD
EUGENE OR
97401-4928
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-2711
  • Fax: 888-975-0250
Mailing address:
  • Phone: 541-485-2711
  • Fax: 888-975-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-18-295
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number31103
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3243
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500764726
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier500747734
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: