Healthcare Provider Details

I. General information

NPI: 1013322411
Provider Name (Legal Business Name): STEVE PETHICK, PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 03/29/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 10TH AVE STE 530
EUGENE OR
97401-3367
US

IV. Provider business mailing address

PO BOX 3163
EUGENE OR
97403-0163
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-7787
  • Fax: 855-646-7433
Mailing address:
  • Phone: 541-687-7787
  • Fax: 855-646-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1569
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. STEPHEN PETHICK
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 541-687-7787