Basic Information
| Provider Information | |||||||||
| NPI: | 1962808741 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EMERGENCE ADDICTION & BEHAVIORAL THERAPIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1324 SKIPPER AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974042149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108524752 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1040 OAK ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413426987 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2014 | ||||||||
| LastUpdateDate: | 11/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | BEAN | ||||||||
| AuthorizedOfficialFirstName: | MICHEAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5416878820 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 101YM0800X | OR | Y | Agencies | Community/Behavioral Health |
No ID Information.