Provider Demographics
NPI:1437214111
Name:POWERS, PETER ANDREW (PHD, LLC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANDREW
Last Name:POWERS
Suffix:
Gender:M
Credentials:PHD, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 OAKWAY CTR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5618
Mailing Address - Country:US
Mailing Address - Phone:541-683-5567
Mailing Address - Fax:541-344-7595
Practice Address - Street 1:220 OAKWAY CTR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5618
Practice Address - Country:US
Practice Address - Phone:541-683-5567
Practice Address - Fax:541-344-7595
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1439103TC1900X, 103TC2200X, 103T00000X
WA2078103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181639Medicaid
OR181639Medicaid