Basic Information
| Provider Information | |||||||||
| NPI: | 1780968552 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASSELL | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | TYRONE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | A.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 F ST APT 4 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974773920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417365926 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 550 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974043212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417432611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2011 | ||||||||
| LastUpdateDate: | 09/28/2011 | ||||||||
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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 | 101Y00000X | 93-0605174 | OR | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.