Healthcare Provider Details

I. General information

NPI: 1275864985
Provider Name (Legal Business Name): VISTA COUNSELING & CONSULTATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 PEARL ST
EUGENE OR
97401-4010
US

IV. Provider business mailing address

1531 PEARL ST
EUGENE OR
97401-4010
US

V. Phone/Fax

Practice location:
  • Phone: 541-517-9733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1572
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500781714
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: JULIE RENEE LISZKA
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 541-517-9733