Provider Demographics
NPI:1841619707
Name:GANJI, POYESH
Entity Type:Individual
Prefix:
First Name:POYESH
Middle Name:
Last Name:GANJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 ORCHARD ST
Mailing Address - Street 2:UNIT 31
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2076
Mailing Address - Country:US
Mailing Address - Phone:541-905-0893
Mailing Address - Fax:
Practice Address - Street 1:1505 ORCHARD STREET
Practice Address - Street 2:UNIT 31
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:541-687-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist