|
| |
|
101 E Broadway Ste 400 Eugene OR 97401-3104 | |
| (704) 506-6267 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 101 E Broadway Ste 400, Eugene, Oregon |
| Authorized Official Name and Position | Leslie Johnson (CEO) |
| Authorized Official Contact | 7045066267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (704) 506-6267 | 101 E Broadway Ste 400 Eugene OR 97401-3104 Ph: (704) 506-6267 |
| NPI Number | 1316717747 |
|---|---|
| Provider Enumeration Date | 01/05/2024 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/24/2024 |
| Medicare PECOS PAC ID | 0941648463 |
|---|---|
| Medicare Enrollment ID | O20240827003465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316717747 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Melody S George |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033409313 PECOS PAC ID: 9335307438 Enrollment ID: I20120221000529 |
| Provider Name | Ida Moadab |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205147675 PECOS PAC ID: 4082940192 Enrollment ID: I20190727000175 |
| Provider Name | Chaunce R Windle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326382300 PECOS PAC ID: 4880923663 Enrollment ID: I20190903002807 |
| Provider Name | Colleen Comeau |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366995862 PECOS PAC ID: 5294162400 Enrollment ID: I20200228001222 |
| Provider Name | Ron Miyaguchi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851784482 PECOS PAC ID: 1355762626 Enrollment ID: I20200522002250 |
| Provider Name | Diana L Frates |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558546465 PECOS PAC ID: 7911135371 Enrollment ID: I20201112001703 |
| Provider Name | Alyssa Nevell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245970961 PECOS PAC ID: 9133594419 Enrollment ID: I20230419001602 |
| Provider Name | Chandra L. Perez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326372681 PECOS PAC ID: 0648682211 Enrollment ID: I20231113000763 |
| Provider Name | Lisa Oland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437517562 PECOS PAC ID: 7810347945 Enrollment ID: I20240102001059 |
| Provider Name | Hannah Lukas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447612809 PECOS PAC ID: 8123470291 Enrollment ID: I20240115001158 |
| Provider Name | Fabiola Del Aguila |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720283211 PECOS PAC ID: 9739329020 Enrollment ID: I20240201000437 |
| Provider Name | Mac Zimdars |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710377395 PECOS PAC ID: 9335671932 Enrollment ID: I20241021003998 |
| Provider Name | Joshua Raphael Atanasio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487138178 PECOS PAC ID: 3476088782 Enrollment ID: I20241122004231 |
| Provider Name | Kristyn Renee Prockish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164112827 PECOS PAC ID: 6002341104 Enrollment ID: I20241126003757 |
| Provider Name | Mallori J Langford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114662707 PECOS PAC ID: 2668907528 Enrollment ID: I20241202001277 |
Emerald Tms, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1140 Willagillespie Rd Ste 44, Eugene, OR 97401 Phone: 541-735-3241 | |
Looking Glass Youth & Family Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2655 Mlk Jr Blvd, Eugene, OR 97401 Phone: 541-682-7950 | |
Looking Glass Youth & Family Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2655 Martin Luther King Jr Blvd, Eugene, OR 97401 Phone: 541-682-7950 | |
University Of Oregon Counseling Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1590 East 13th Avenue, Eugene, OR 97403 Phone: 541-346-3227 Fax: 541-346-2842 | |
Steve Pethick, Phd Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 401 E 10th Ave Ste 530, Eugene, OR 97401 Phone: 541-687-7787 Fax: 855-646-7433 | |
Behavioral Health Center Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 399 E 10th Ave, Suite #113, Eugene, OR 97401 Phone: 541-342-8208 Fax: 541-687-8159 | |
New Destiny Counseling, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5 E 24th Ave, Eugene, OR 97405 Phone: 541-515-0900 Fax: 541-799-0789 |