Provider Demographics
NPI:1275357212
Name:WILLAMETTE VALLEY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:WILLAMETTE VALLEY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES-DYKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:541-337-0792
Mailing Address - Street 1:3341 MURRY DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6246
Mailing Address - Country:US
Mailing Address - Phone:541-337-0792
Mailing Address - Fax:
Practice Address - Street 1:132 E BROADWAY STE 214
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3150
Practice Address - Country:US
Practice Address - Phone:541-337-0792
Practice Address - Fax:541-275-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty