Basic Information
| Provider Information | |||||||||
| NPI: | 1780227702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | GERARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1880 HOLLY AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974081641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047234068 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1790 W 11TH AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974023871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417432611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2019 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.