Healthcare Provider Details

I. General information

NPI: 1619494424
Provider Name (Legal Business Name): LIBERATED SPIRIT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 CHAMBERS ST
EUGENE OR
97402-3706
US

IV. Provider business mailing address

1077 CHAMBERS ST
EUGENE OR
97402-3706
US

V. Phone/Fax

Practice location:
  • Phone: 541-972-2837
  • Fax: 541-505-9306
Mailing address:
  • Phone: 541-972-2837
  • Fax: 541-505-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC169614
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20855
License Number StateOR

VIII. Authorized Official

Name: DR. ERIN ROSE FUSSY
Title or Position: OWNER
Credential: DACM, LAC, LMT
Phone: 718-306-2887