Provider Demographics
NPI:1154676773
Name:PETERSON, EMILY ADAMS (MSW, QMHP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ADAMS
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, QMHP
Mailing Address - Street 1:215 E ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1170 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3541
Practice Address - Country:US
Practice Address - Phone:541-743-4340
Practice Address - Fax:541-743-4369
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663467Medicaid