Healthcare Provider Details

I. General information

NPI: 1942860408
Provider Name (Legal Business Name): KRISTEN LEIGHANNE CURTIS LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 LAWRENCE ST
EUGENE OR
97401-2221
US

IV. Provider business mailing address

PO BOX 12244
EUGENE OR
97440-4444
US

V. Phone/Fax

Practice location:
  • Phone: 458-209-4272
  • Fax:
Mailing address:
  • Phone: 458-209-4272
  • 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: KRISTEN LEIGHANNE CURTIS
Title or Position: OWNER
Credential: LCSW
Phone: 458-209-4272