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General NPI Number Information
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NPI Number | 1891272324
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Entity Type | Organization
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Legal Business Name | CRESSALL PSYCHIATRIC LLC
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 240 E 12TH AVE
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City | EUGENE
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State | OR
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Zip | 97401-3245
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Country | US
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Telephone | 541-232-3131
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Fax | 541-357-9952
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Provider Business Mailing Address
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Address Line | PO BOX 42283
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City | EUGENE
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State | OR
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Zip | 97404-0600
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Country | US
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Telephone | 541-232-3131
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Fax | 541-357-9952
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Authorized Official
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Title or Position | OWNER
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Name | CASSANDRE CRESSALL
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Credential | PMHNP-BC
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Telephone | 541-232-3131
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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 | 201500826NP-PP
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License Number State | OR
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