Healthcare Provider Details

I. General information

NPI: 1952117913
Provider Name (Legal Business Name): CHRISTINE CARL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 OLIVE STREET SUITE 307 576 OLIVE STREET SUITE 307
EUGENE OR
97401
US

IV. Provider business mailing address

576 OLIVE ST STE 307
EUGENE OR
97401-2995
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-7303
  • Fax:
Mailing address:
  • Phone: 541-344-7303
  • 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: