Provider Demographics
NPI:1952569725
Name:PETER A. POWERS, PH.D., LLC
Entity Type:Organization
Organization Name:PETER A. POWERS, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-683-5567
Mailing Address - Street 1:220 OAKWAY CTR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5618
Mailing Address - Country:US
Mailing Address - Phone:541-683-5567
Mailing Address - Fax:541-344-7595
Practice Address - Street 1:220 OAKWAY CTR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5618
Practice Address - Country:US
Practice Address - Phone:541-683-5567
Practice Address - Fax:541-344-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181639Medicaid
OR181639Medicaid