Healthcare Provider Details

I. General information

NPI: 1952794448
Provider Name (Legal Business Name): COUNSELING AND TESTING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 EAST 13TH AVENUE
EUGENE OR
97403-1280
US

IV. Provider business mailing address

1590 EAST 13TH AVENUE
EUGENE OR
97403-1280
US

V. Phone/Fax

Practice location:
  • Phone: 541-346-3227
  • Fax: 541-346-2842
Mailing address:
  • Phone: 541-346-3227
  • Fax: 541-346-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1500
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. SHELLY KERR
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 541-346-3227