Healthcare Provider Details

I. General information

NPI: 1265364400
Provider Name (Legal Business Name): GONZALO CAMP LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E 11TH AVE STE 3
EUGENE OR
97401-3370
US

IV. Provider business mailing address

1292 HIGH ST # 147
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-781-8124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GONZALO CAMP
Title or Position: OWNER
Credential: LCSW
Phone: 479-301-9879