Provider Demographics
NPI:1902255920
Name:THOMPSON, BRANDY TAYLER
Entity Type:Individual
Prefix:
First Name:BRANDY TAYLER
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLER
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1292 HIGH ST # 435
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3238
Mailing Address - Country:US
Mailing Address - Phone:541-234-3389
Mailing Address - Fax:458-220-3179
Practice Address - Street 1:291 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3409
Practice Address - Country:US
Practice Address - Phone:541-234-3389
Practice Address - Fax:458-220-3179
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI2903101YP2500X
ORR7819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional