Provider Demographics
NPI:1801651617
Name:ALIVE COUNSELING CLINIC, LLC
Entity type:Organization
Organization Name:ALIVE COUNSELING CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER-MASKIELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-357-3248
Mailing Address - Street 1:777 HIGH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2750
Mailing Address - Country:US
Mailing Address - Phone:541-216-4034
Mailing Address - Fax:541-216-4034
Practice Address - Street 1:777 HIGH ST STE 130
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2750
Practice Address - Country:US
Practice Address - Phone:541-216-4034
Practice Address - Fax:541-216-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty