Healthcare Provider Details

I. General information

NPI: 1114560323
Provider Name (Legal Business Name): NW THERAPY COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 2ND AVE STE 104E
EUGENE OR
97401-2452
US

IV. Provider business mailing address

400 E 2ND AVE STE 104E
EUGENE OR
97401-2452
US

V. Phone/Fax

Practice location:
  • Phone: 541-912-8591
  • Fax: 541-735-3182
Mailing address:
  • Phone: 541-912-8591
  • Fax: 541-735-3182

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: BRANDON MARSHALL
Title or Position: PRESIDENT
Credential: LPC
Phone: 541-912-8591