Healthcare Provider Details

I. General information

NPI: 1043875164
Provider Name (Legal Business Name): INDIVIDUAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 CLUB RD STE 200
EUGENE OR
97401-2460
US

IV. Provider business mailing address

114 W SUPERIOR ST
DULUTH MN
55802-3000
US

V. Phone/Fax

Practice location:
  • Phone: 651-347-8172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER MEILAHN
Title or Position: FOUNDER
Credential: LPC
Phone: 651-347-8172