Provider Demographics
NPI:1962213546
Name:COLASURDO, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:COLASURDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 GOODPASTURE ISLAND RD APT 215
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1534
Mailing Address - Country:US
Mailing Address - Phone:541-357-2066
Mailing Address - Fax:
Practice Address - Street 1:1600 EXECUTIVE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7113
Practice Address - Country:US
Practice Address - Phone:541-600-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health