Provider Demographics
NPI:1013322411
Name:STEVE PETHICK, PHD PC
Entity Type:Organization
Organization Name:STEVE PETHICK, PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETHICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-687-7787
Mailing Address - Street 1:PO BOX 3163
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-0163
Mailing Address - Country:US
Mailing Address - Phone:541-687-7787
Mailing Address - Fax:855-646-7433
Practice Address - Street 1:401 E 10TH AVE STE 530
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3367
Practice Address - Country:US
Practice Address - Phone:541-687-7787
Practice Address - Fax:855-646-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1569251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health