Healthcare Provider Details

I. General information

NPI: 1245852011
Provider Name (Legal Business Name): TERRY N HOAGLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 COUNTRY CLUB RD STE 222
EUGENE OR
97401-2238
US

IV. Provider business mailing address

1262 MONTECELLO DR
EUGENE OR
97404-3849
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-6000
  • Fax: 541-344-8239
Mailing address:
  • Phone: 541-619-7129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19-QMHPC-00864
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: