Provider Demographics
NPI:1760563282
Name:DUTOIT, CHAZ (QMHA)
Entity Type:Individual
Prefix:MR
First Name:CHAZ
Middle Name:
Last Name:DUTOIT
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:MR
Other - First Name:PHILIP
Other - Middle Name:JON
Other - Last Name:NERBERGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1966 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1933
Mailing Address - Country:US
Mailing Address - Phone:541-342-5088
Mailing Address - Fax:541-342-1150
Practice Address - Street 1:1966 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1933
Practice Address - Country:US
Practice Address - Phone:541-342-5088
Practice Address - Fax:541-342-1150
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health