Healthcare Provider Details

I. General information

NPI: 1629519954
Provider Name (Legal Business Name): EUGENE PSYCHOLOGICAL ASSESSMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 WILLAMETTE ST # 3F
EUGENE OR
97405-3309
US

IV. Provider business mailing address

3225 WILLAMETTE ST. 3F
EUGENE OR
97405-3506
US

V. Phone/Fax

Practice location:
  • Phone: 435-760-9927
  • Fax:
Mailing address:
  • Phone: 435-760-9927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2860
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: GRETCHEN SCHEIDEL
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 541-972-3958