Basic Information
| Provider Information | |||||||||
| NPI: | 1578055778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARZYNSKI | ||||||||
| FirstName: | CHANEL | ||||||||
| MiddleName: | JOY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 341 E 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416874000 | ||||||||
| FaxNumber: | 5413427987 | ||||||||
| Practice Location | |||||||||
| Address1: | 1345 BIRCH AVE | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974241416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419423939 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | OR | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.