Healthcare Provider Details

I. General information

NPI: 1447401203
Provider Name (Legal Business Name): WILLAMETTE COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB RD STE 120
EUGENE OR
97401
US

IV. Provider business mailing address

66 CLUB RD STE 120
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-2800
  • Fax: 541-345-4419
Mailing address:
  • Phone: 541-345-2800
  • Fax: 541-345-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
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: DR. TERI STRONG
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 541-345-2800