Healthcare Provider Details

I. General information

NPI: 1821853334
Provider Name (Legal Business Name): BLUESTAR BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 BARRINGTON AVE
EUGENE OR
97401-7084
US

IV. Provider business mailing address

1574 COBURG RD # 1574
EUGENE OR
97401-4802
US

V. Phone/Fax

Practice location:
  • Phone: 541-979-6895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
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: JENNIFER OLSON
Title or Position: OWNER
Credential: MD
Phone: 541-979-6895