Healthcare Provider Details

I. General information

NPI: 1174958631
Provider Name (Legal Business Name): SOPHIE E BLOCH MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W 13TH AVE STE 104
EUGENE OR
97401-3675
US

IV. Provider business mailing address

227 W 13TH AVE STE 104
EUGENE OR
97401-3675
US

V. Phone/Fax

Practice location:
  • Phone: 541-554-6743
  • Fax: 971-266-4452
Mailing address:
  • Phone: 541-554-6743
  • Fax: 971-226-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7130
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60392149
License Number StateWA

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: