Provider Demographics
NPI:1114560323
Name:NW THERAPY COLLECTIVE LLC
Entity Type:Organization
Organization Name:NW THERAPY COLLECTIVE LLC
Other - Org Name:BRANDON MARSHALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-912-8591
Mailing Address - Street 1:400 E 2ND AVE STE 104E
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2452
Mailing Address - Country:US
Mailing Address - Phone:541-912-8591
Mailing Address - Fax:541-735-3182
Practice Address - Street 1:400 E 2ND AVE STE 104E
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2452
Practice Address - Country:US
Practice Address - Phone:541-912-8591
Practice Address - Fax:541-735-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty