Healthcare Provider Details

I. General information

NPI: 1376015610
Provider Name (Legal Business Name): EUGENE CENTER FOR ANXIETY AND STRESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BROADWAY STE 400
EUGENE OR
97401-3104
US

IV. Provider business mailing address

101 E BROADWAY STE 400
EUGENE OR
97401-3104
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-9764
  • Fax:
Mailing address:
  • Phone: 541-357-9764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: STACY CLOYD
Title or Position: SECRETARY
Credential:
Phone: 904-605-4986