Provider Demographics
NPI:1942796388
Name:DE CORDOBA, ANTHONY (MS, NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:DE CORDOBA
Suffix:
Gender:M
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 E 36TH PL
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4522
Mailing Address - Country:US
Mailing Address - Phone:503-928-2521
Mailing Address - Fax:
Practice Address - Street 1:1320 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4127
Practice Address - Country:US
Practice Address - Phone:541-359-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health