Healthcare Provider Details

I. General information

NPI: 1093203523
Provider Name (Legal Business Name): AVODAH THERAPY SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 02/25/2023
Certification Date: 02/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 RIVER RD STE F
EUGENE OR
97404-5013
US

IV. Provider business mailing address

2620 RIVER RD STE F
EUGENE OR
97404-5013
US

V. Phone/Fax

Practice location:
  • Phone: 458-240-2893
  • Fax: 541-505-8794
Mailing address:
  • Phone: 541-606-5460
  • Fax: 541-505-8794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MARIAN AUDREY STIEGELER
Title or Position: OWNER
Credential: LPC
Phone: 458-240-2893