Healthcare Provider Details

I. General information

NPI: 1497084602
Provider Name (Legal Business Name): GALEN LESLIE PHIPPS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 09/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SHELTON MCMURPHEY BLVD STE 101
EUGENE OR
97401-5015
US

IV. Provider business mailing address

PO BOX 346
MCKENZIE BRIDGE OR
97413-0346
US

V. Phone/Fax

Practice location:
  • Phone: 541-210-8090
  • Fax:
Mailing address:
  • Phone: 541-822-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL1619
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500661233
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: