Healthcare Provider Details

I. General information

NPI: 1033290028
Provider Name (Legal Business Name): GINA MARIE TORMOHLEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 MARTIN LUTHER KING JR. BLVD.
EUGENE OR
97401
US

IV. Provider business mailing address

987 W 5TH AVE
EUGENE OR
97402-5105
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-7593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4854
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
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:
Title or Position:
Credential:
Phone: