Healthcare Provider Details

I. General information

NPI: 1992684104
Provider Name (Legal Business Name): ELIZABETH BROOKE PERINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 WILLAMETTE STREET SUITE 301 PMB 303
EUGENE OR
97401
US

IV. Provider business mailing address

1711 WILLAMETTE STREET SUITE 301 PMB 303
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-255-5434
  • Fax:
Mailing address:
  • Phone: 541-255-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
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:
Title or Position:
Credential:
Phone: