Healthcare Provider Details

I. General information

NPI: 1922303429
Provider Name (Legal Business Name): PROFESSIONAL CONSULTING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 TIARA ST
EUGENE OR
97405-6309
US

IV. Provider business mailing address

PO BOX 5510
EUGENE OR
97405-0510
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-9334
  • Fax: 541-345-0048
Mailing address:
  • Phone: 541-344-9334
  • Fax: 541-345-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0256
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. MARK JAY MANN
Title or Position: PRESIDENT/MENTAL HEALTH COUNSELOR
Credential: L.P.C,; C.R.C.
Phone: 541-344-9334