Healthcare Provider Details

I. General information

NPI: 1144004490
Provider Name (Legal Business Name): FIRST RESPONDER LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E 5TH AVENUE, SUITE 228
EUGENE OR
97401
US

IV. Provider business mailing address

2161 GROVE ST
EUGENE OR
97404-2244
US

V. Phone/Fax

Practice location:
  • Phone: 541-517-5177
  • Fax:
Mailing address:
  • Phone: 541-431-1727
  • Fax:

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: JENNIFER LYNN GRAHAM
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 541-517-5177