MEDICARE: SACRED PHASES COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1184573461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED PHASES COUNSELING LLC

Provider Business Mailing Address
First Line	:	3575 DONALD ST STE 250
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-4783
Country	:	US
Telephone Number	:	458-215-1170
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 DONALD ST STE 250
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-4783
Country	:	US
Telephone Number	:	458-215-1170
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMY MAY
Credential	:	LCSW
Telephone Number	:	458-215-1170

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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