Provider Demographics
NPI:1295065530
Name:EUGENE THERAPY LLC
Entity type:Organization
Organization Name:EUGENE THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-605-4986
Mailing Address - Street 1:401 E 10TH AVE
Mailing Address - Street 2:STE 330
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3317
Mailing Address - Country:US
Mailing Address - Phone:541-868-2004
Mailing Address - Fax:
Practice Address - Street 1:401 E 10TH AVE
Practice Address - Street 2:STE 330
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3317
Practice Address - Country:US
Practice Address - Phone:541-868-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2145101YP2500X
ORT0624106H00000X
OR539991363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty