1528106531 NPI number — MRS. LISA M SPRING CADC II, QMHA-1

Table of content: MRS. LISA M SPRING CADC II, QMHA-1 (NPI 1528106531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528106531 NPI number — MRS. LISA M SPRING CADC II, QMHA-1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRING
Provider First Name:
LISA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CADC II, QMHA-1
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPRING
Provider Other First Name:
LISA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CLINICAL SUPERVISOR
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528106531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
687 CHESHIRE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97402-5060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-684-4100
Provider Business Mailing Address Fax Number:
541-684-4156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 W. 12TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-762-4414
Provider Business Practice Location Address Fax Number:
541-344-0772
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  12-06-80 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 20-QMHA-I-02890 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50070768 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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