Healthcare Provider Details

I. General information

NPI: 1689363897
Provider Name (Legal Business Name): KNIGHT PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 415
EUGENE OR
97401-3155
US

IV. Provider business mailing address

132 E BROADWAY STE 415
EUGENE OR
97401-3155
US

V. Phone/Fax

Practice location:
  • Phone: 541-579-8760
  • Fax: 541-530-3053
Mailing address:
  • Phone: 541-579-8760
  • Fax: 541-530-3053

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: ZACHARY KNIGHT
Title or Position: OWNER
Credential: LCSW
Phone: 541-579-8760