Provider Demographics
NPI:1750855094
Name:MARSHALL, BRANDON (LPC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 2ND AVE STE 104E
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2452
Mailing Address - Country:US
Mailing Address - Phone:541-912-8591
Mailing Address - Fax:541-735-3182
Practice Address - Street 1:400 E 2ND AVE STE 104E
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2452
Practice Address - Country:US
Practice Address - Phone:541-912-8591
Practice Address - Fax:541-735-3182
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional