Healthcare Provider Details

I. General information

NPI: 1558427781
Provider Name (Legal Business Name): HEALTH PSYCHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 WILLAGILLESPIE RD STE. 200
EUGENE OR
97401-6798
US

IV. Provider business mailing address

1045 WILLAGILLESPIE RD STE. 200
EUGENE OR
97401-6798
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-7171
  • Fax: 541-284-1765
Mailing address:
  • Phone: 541-343-7171
  • Fax: 541-284-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2504
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0755
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. CRAIG GERALD THORSEN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 541-343-7171