Healthcare Provider Details

I. General information

NPI: 1902054844
Provider Name (Legal Business Name): ELIZABETH POWNALL M.A., QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 COUNTRY CLUB ROAD
EUGENE OR
97405
US

IV. Provider business mailing address

410 N 9TH ST
COTTAGE GROVE OR
97424-1307
US

V. Phone/Fax

Practice location:
  • Phone: 542-343-1728
  • Fax: 855-282-3544
Mailing address:
  • Phone: 541-942-2850
  • Fax: 541-942-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC-2853
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: