Healthcare Provider Details

I. General information

NPI: 1093679623
Provider Name (Legal Business Name): BRETT BRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4969 HIGHWAY 101 UNIT 3
FLORENCE OR
97439-7803
US

IV. Provider business mailing address

78 CENTENNIAL LOOP STE A
EUGENE OR
97401-7900
US

V. Phone/Fax

Practice location:
  • Phone: 541-393-0777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: