Healthcare Provider Details

I. General information

NPI: 1346874989
Provider Name (Legal Business Name): CARLEY K CANTWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 02/22/2020
Certification Date: 02/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 W 12TH AVE
EUGENE OR
97401-3409
US

IV. Provider business mailing address

291 W 12TH AVE
EUGENE OR
97401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-3391
  • Fax:
Mailing address:
  • Phone: 541-505-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: CARLEY K CANTWELL
Title or Position: OWNER
Credential: LCSW
Phone: 541-505-3391