Healthcare Provider Details

I. General information

NPI: 1285904094
Provider Name (Legal Business Name): SUSAN J MCPHERSON PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 WILLAGILLESPIE RD STE 202
EUGENE OR
97401-2104
US

IV. Provider business mailing address

975 WILLAGILLESPIE RD STE 202
EUGENE OR
97401-2104
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-7230
  • Fax: 541-343-9801
Mailing address:
  • Phone: 541-342-7230
  • Fax: 541-343-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number593
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number593
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUSAN J. MCPHERSON
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 542-342-7230