Provider Demographics
NPI:1114574936
Name:INVICTUS THERAPY AND CONSULTATION LLC
Entity Type:Organization
Organization Name:INVICTUS THERAPY AND CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:541-313-6199
Mailing Address - Street 1:911 COUNTRY CLUB RD STE 290
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1301
Mailing Address - Country:US
Mailing Address - Phone:541-313-6199
Mailing Address - Fax:541-576-8977
Practice Address - Street 1:911 COUNTRY CLUB RD STE 290
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1301
Practice Address - Country:US
Practice Address - Phone:541-313-6199
Practice Address - Fax:541-576-8977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500662798Medicaid