Healthcare Provider Details

I. General information

NPI: 1255812566
Provider Name (Legal Business Name): CHAMPION FAMILY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 COUNTRY CLUB RD STE B
EUGENE OR
97401-2479
US

IV. Provider business mailing address

1574 COBURG RD
EUGENE OR
97401-4802
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-7200
  • Fax: 844-364-4271
Mailing address:
  • Phone: 541-343-7200
  • Fax: 844-364-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
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: JESSICA CHAMPION
Title or Position: OWNER
Credential: LMFT
Phone: 541-632-3909