Healthcare Provider Details

I. General information

NPI: 1750855094
Provider Name (Legal Business Name): BRANDON MARSHALL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2019
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 NumberC5153
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: