Provider Demographics
NPI:1437328267
Name:PETERSON, BRIAN CHRISTOPHER (BS PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:PETERSON
Suffix:
Gender:M
Credentials:BS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-2562
Mailing Address - Country:US
Mailing Address - Phone:541-689-3111
Mailing Address - Fax:541-607-0625
Practice Address - Street 1:2485 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-2562
Practice Address - Country:US
Practice Address - Phone:541-689-3111
Practice Address - Fax:541-607-0625
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator