Healthcare Provider Details

I. General information

NPI: 1417842725
Provider Name (Legal Business Name): OREGON NEUROFEEDBACK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 E 13TH AVE STE 105
EUGENE OR
97401-4250
US

IV. Provider business mailing address

987 LADD AVE
JUNCTION CITY OR
97448-8606
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-5705
  • Fax:
Mailing address:
  • Phone: 541-221-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL PECUE
Title or Position: PRESIDENT
Credential: LPC
Phone: 458-205-5705