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General NPI Number Information
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NPI Number | 1417842725
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Entity Type | Organization
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Legal Business Name | OREGON NEUROFEEDBACK LLC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 492 E 13TH AVE STE 105
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City | EUGENE
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State | OR
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Zip | 97401-4250
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Country | US
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Telephone | 458-205-5705
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Fax |
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Provider Business Mailing Address
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Address Line | 987 LADD AVE
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City | JUNCTION CITY
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State | OR
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Zip | 97448-8606
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Country | US
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Telephone | 541-221-0246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL PECUE
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Credential | LPC
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Telephone | 458-205-5705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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