Healthcare Provider Details

I. General information

NPI: 1982849121
Provider Name (Legal Business Name): LANE COUNTY YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 MARTIN LUTHER KING JR BLVD
EUGENE OR
97401-5901
US

IV. Provider business mailing address

2727 MARTIN LUTHER KING JR BLVD
EUGENE OR
97401-5901
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3608
  • Fax: 541-682-3550
Mailing address:
  • Phone: 541-682-3608
  • Fax: 541-682-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
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: PATTI ROBB
Title or Position: DIVISION MANAGER YOUTH SERVICES
Credential:
Phone: 541-682-4786