Healthcare Provider Details

I. General information

NPI: 1982855219
Provider Name (Legal Business Name): WILLAMETTE COMMUNITY HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SUZANNE WAY STE 120
EUGENE OR
97408-7319
US

IV. Provider business mailing address

2650 SUZANNE WAY STE 120
EUGENE OR
97408-7319
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-2800
  • Fax: 541-345-4419
Mailing address:
  • Phone: 541-345-2800
  • Fax: 541-345-4419

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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
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: ERIC VAN HOUTEN
Title or Position: COO
Credential: LCSW
Phone: 541-228-3001