Headwaters Therapy LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

HEADWATERS THERAPY LLC

Practice address

927 Country Club Rd Ste 200
Eugene, OR 97401-2272

Phone

(541) 604-8822

Fax

(541) 359-1134

NPI assigned

Feb 28, 2020

Last updated

Jun 25, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ryan S Smith, M.ED, LMFTNPI 1811063845

Title

Licensed Marriage & Family Therapis

Phone

(541) 868-2004

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan S Smith, M.ED., LMFT

  • Marriage & Family Therapist
  • Eugene, OR
  • NPI 1811063845

  Mental Health

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1538793591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 COUNTRY CLUB RD STE 200",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012272",
            "telephone_number": "541-604-8822",
            "fax_number": "541-359-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 COUNTRY CLUB RD STE 200",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012272",
            "telephone_number": "541-604-8822",
            "fax_number": "541-359-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEADWATERS THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-28",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "LICENSED MARRIAGE & FAMILY THERAPIS",
        "authorized_official_telephone_number": "541-868-2004",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.ED, LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Healing Pathways of Eugene LLC
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• Marriage & Family Therapist in Eugene, OR
• Providers in Eugene, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.