Healthcare Provider Details

I. General information

NPI: 1588719595
Provider Name (Legal Business Name): GARY NEAL REISS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W 17TH AVE
EUGENE OR
97401-3869
US

IV. Provider business mailing address

412 W 17TH AVE
EUGENE OR
97401-3869
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-8060
  • Fax: 541-686-6647
Mailing address:
  • Phone: 541-686-8060
  • Fax: 541-686-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL0746
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: