Healthcare Provider Details

I. General information

NPI: 1730922634
Provider Name (Legal Business Name): RIISA HUMPHREY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 WILLAGILLESPIE RD STE 22
EUGENE OR
97401-6723
US

IV. Provider business mailing address

1142 WILLAGILLESPIE RD STE 22
EUGENE OR
97401-6723
US

V. Phone/Fax

Practice location:
  • Phone: 541-970-1970
  • Fax:
Mailing address:
  • Phone: 541-970-1970
  • Fax: 458-223-7265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. RIISA LEA HUMPHREY
Title or Position: OWNER/THERAPIST
Credential: MA, LPC, NCC
Phone: 541-505-2100