Provider Demographics
NPI:1942806187
Name:ELLIOTT-WRIGHT, PHINAZEE DUPREE
Entity Type:Individual
Prefix:
First Name:PHINAZEE
Middle Name:DUPREE
Last Name:ELLIOTT-WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 E 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4281
Mailing Address - Country:US
Mailing Address - Phone:323-694-8888
Mailing Address - Fax:
Practice Address - Street 1:1585 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1657
Practice Address - Country:US
Practice Address - Phone:323-694-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1041S0200X, 261QM0855X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health