Healthcare Provider Details

I. General information

NPI: 1972216877
Provider Name (Legal Business Name): FJORD COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 WILLAMETTE ST STE 202
EUGENE OR
97405-3170
US

IV. Provider business mailing address

PO BOX 40142
EUGENE OR
97404-0020
US

V. Phone/Fax

Practice location:
  • Phone: 541-234-3090
  • Fax: 541-735-9480
Mailing address:
  • Phone: 541-234-3090
  • Fax:

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:

# 1
Identifier500725923
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier500731705
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. TODD B JETER
Title or Position: OWNER/LEAD THERAPIST
Credential: LCSW, CADC III
Phone: 541-954-3485