Healthcare Provider Details

I. General information

NPI: 1952569725
Provider Name (Legal Business Name): PETER A. POWERS, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 OAKWAY CTR
EUGENE OR
97401-5618
US

IV. Provider business mailing address

220 OAKWAY CTR
EUGENE OR
97401-5618
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-5567
  • Fax: 541-344-7595
Mailing address:
  • Phone: 541-683-5567
  • Fax: 541-344-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1439
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier181639
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: PETER ANDREW POWERS
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 541-683-5567