Provider Demographics
NPI:1588770887
Name:STUART, BRANDT RICHARD (PA LPC)
Entity type:Individual
Prefix:MR
First Name:BRANDT
Middle Name:RICHARD
Last Name:STUART
Suffix:
Gender:M
Credentials:PA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W.13TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-342-3875
Mailing Address - Fax:541-653-3572
Practice Address - Street 1:245 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-342-3875
Practice Address - Fax:541-683-3572
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor