Healthcare Provider Details

I. General information

NPI: 1144148693
Provider Name (Legal Business Name): AMY M RACINE CRM II, QMHA-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 HIGH ST
EUGENE OR
97401-3238
US

IV. Provider business mailing address

1258 HIGH ST
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-8437
  • Fax: 458-221-7001
Mailing address:
  • Phone: 541-342-8437
  • Fax: 458-221-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: