Healthcare Provider Details

I. General information

NPI: 1992473433
Provider Name (Legal Business Name): CHRISTOPHER SCOTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 RIVER RD N STE B
KEIZER OR
97303
US

IV. Provider business mailing address

1292 HIGH ST # 1026
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-321-6226
  • Fax:
Mailing address:
  • Phone: 541-321-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: CHRISTOPHER SCOTT
Title or Position: OWNER
Credential: LCSW
Phone: 458-205-1580