Provider Demographics
NPI:1093203523
Name:AVODAH THERAPY SERVICES CORPORATION
Entity Type:Organization
Organization Name:AVODAH THERAPY SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:AUDREY
Authorized Official - Last Name:STIEGELER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:458-240-2893
Mailing Address - Street 1:2620 RIVER RD STE F
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-5013
Mailing Address - Country:US
Mailing Address - Phone:541-606-5460
Mailing Address - Fax:541-505-8794
Practice Address - Street 1:2620 RIVER RD STE F
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5013
Practice Address - Country:US
Practice Address - Phone:458-240-2893
Practice Address - Fax:541-505-8794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QM0855X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health