Healthcare Provider Details

I. General information

NPI: 1073241030
Provider Name (Legal Business Name): INNER ROOM SOMATIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 LAWRENCE ST
EUGENE OR
97401-2828
US

IV. Provider business mailing address

887 E 39TH PL
EUGENE OR
97405-4539
US

V. Phone/Fax

Practice location:
  • Phone: 541-275-6349
  • Fax: 541-516-7085
Mailing address:
  • Phone: 541-275-6349
  • Fax: 541-516-7085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional 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: CHRISTOPHER BREHM
Title or Position: OWNER
Credential:
Phone: 541-275-6349