Provider Demographics
NPI:1578629796
Name:THORSEN, CRAIG GERALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:GERALD
Last Name:THORSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 WILLAGILLESPIE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6798
Mailing Address - Country:US
Mailing Address - Phone:541-343-7171
Mailing Address - Fax:541-284-1765
Practice Address - Street 1:1045 WILLAGILLESPIE RD
Practice Address - Street 2:STE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6798
Practice Address - Country:US
Practice Address - Phone:541-343-7171
Practice Address - Fax:541-284-1765
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0755103TC2200X, 103TF0000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily