Healthcare Provider Details

I. General information

NPI: 1952683377
Provider Name (Legal Business Name): VAN BIVENS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 DONALD ST
EUGENE OR
97405-4730
US

IV. Provider business mailing address

3780 DONALD ST
EUGENE OR
97405-4730
US

V. Phone/Fax

Practice location:
  • Phone: 479-567-1240
  • Fax:
Mailing address:
  • Phone: 479-567-1240
  • Fax: 479-567-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL13923
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: