Healthcare Provider Details

I. General information

NPI: 1740771682
Provider Name (Legal Business Name): LINDSEY DEHERRERA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2018
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 OAK ST STE 100
EUGENE OR
97401-3566
US

IV. Provider business mailing address

1355 OAK ST STE 100
EUGENE OR
97401-3566
US

V. Phone/Fax

Practice location:
  • Phone: 541-632-3826
  • Fax:
Mailing address:
  • Phone: 541-632-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT98749
License Number StateCA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LINDSEY DEHERRERA
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 541-632-3826