Healthcare Provider Details

I. General information

NPI: 1245635002
Provider Name (Legal Business Name): TERI L. STRONG, PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB ROAD SUITE 360
EUGENE OR
97401-2463
US

IV. Provider business mailing address

66 CLUB ROAD SUITE 360
EUGENE OR
97401-2463
US

V. Phone/Fax

Practice location:
  • Phone: 541-606-4209
  • Fax: 541-972-8779
Mailing address:
  • Phone: 541-606-4209
  • Fax: 541-972-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1258
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number080046006
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1258
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500691345
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: ELIZABETH HATCH
Title or Position: CREDENTIALING/OFFICE MANAGER
Credential:
Phone: 541-606-4209