Healthcare Provider Details

I. General information

NPI: 1114141520
Provider Name (Legal Business Name): JON WILLIAM TALEBREZA-MAY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E 10TH AVE
EUGENE OR
97401-3380
US

IV. Provider business mailing address

399 E 10TH AVE
EUGENE OR
97401-3380
US

V. Phone/Fax

Practice location:
  • Phone: 541-868-2004
  • Fax:
Mailing address:
  • Phone: 505-868-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6138
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06318
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6895
License Number StateOR

VII. Legacy identifiers

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

# 1
IdentifierL6895
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOREGON BOARD OF SOCIAL WORK EXAMINERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: