Healthcare Provider Details
I. General information
NPI: 1225857899
Provider Name (Legal Business Name): EUGENE BEHAVIORAL HEALTH LLC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
66 CLUB RD STE 360
EUGENE OR
97401-2463
US
IV. Provider business mailing address
38850 DEERHORN RD
SPRINGFIELD OR
97478-8540
US
V. Phone/Fax
- Phone: 541-240-2100
- Fax: 458-202-7028
- Phone: 971-563-2164
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MS.
KRISTI
KETRENOS
STEINBACHER
Title or Position: DIRECTOR
Credential: PMHNP
Phone: 541-240-2100