Healthcare Provider Details

I. General information

NPI: 1366263188
Provider Name (Legal Business Name): KAMILLAH SCALES MS, NCC, PC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 COUNTRY CLUB RD STE B
EUGENE OR
97401-2479
US

IV. Provider business mailing address

240 COUNTRY CLUB RD STE B
EUGENE OR
97401-2479
US

V. Phone/Fax

Practice location:
  • Phone: 541-520-4852
  • Fax:
Mailing address:
  • Phone: 541-520-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR9613
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: