Provider Demographics
NPI:1689122566
Name:CHANCE, ZEM XANDER (MFT)
Entity Type:Individual
Prefix:
First Name:ZEM
Middle Name:XANDER
Last Name:CHANCE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JANE
Other - Last Name:KLOSIEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:291 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3409
Mailing Address - Country:US
Mailing Address - Phone:541-525-9898
Mailing Address - Fax:541-525-9899
Practice Address - Street 1:291 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3409
Practice Address - Country:US
Practice Address - Phone:541-525-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist