Healthcare Provider Details

I. General information

NPI: 1255141016
Provider Name (Legal Business Name): BRIANNA MINTZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 E 10TH AVE # 101
EUGENE OR
97401-3255
US

IV. Provider business mailing address

1292 HIGH ST # 307
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-803-2499
  • Fax:
Mailing address:
  • Phone: 541-803-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3841
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: