Provider Demographics
NPI:1245635002
Name:TERI L. STRONG, PHD, LLC
Entity type:Organization
Organization Name:TERI L. STRONG, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-606-4209
Mailing Address - Street 1:66 CLUB ROAD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2463
Mailing Address - Country:US
Mailing Address - Phone:541-606-4209
Mailing Address - Fax:541-972-8779
Practice Address - Street 1:66 CLUB ROAD
Practice Address - Street 2:SUITE 360
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2463
Practice Address - Country:US
Practice Address - Phone:541-606-4209
Practice Address - Fax:541-972-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1258103TC0700X, 103T00000X
OR080046006163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500691345Medicaid
OR500691345Medicaid
ORR180537Medicare PIN