Healthcare Provider Details

I. General information

NPI: 1437214111
Provider Name (Legal Business Name): PETER ANDREW POWERS PH.D., L.L.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2006
Last Update Date: 04/01/2008
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 TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1439
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2078
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1439
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
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:
Title or Position:
Credential:
Phone: