Provider Demographics
NPI:1588033583
Name:HEJAZI, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HEJAZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 CENTENNIAL LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2443
Mailing Address - Country:US
Mailing Address - Phone:541-505-8426
Mailing Address - Fax:
Practice Address - Street 1:71 CENTENNIAL LOOP STE A
Practice Address - Street 2:SHELTERCARE
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2443
Practice Address - Country:US
Practice Address - Phone:541-505-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-20
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst