Provider Demographics
NPI:1356404172
Name:PETHICK, STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:PETHICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3163
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-0163
Mailing Address - Country:US
Mailing Address - Phone:541-687-7787
Mailing Address - Fax:541-687-9334
Practice Address - Street 1:401 E 10TH AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3367
Practice Address - Country:US
Practice Address - Phone:541-687-7787
Practice Address - Fax:855-646-7433
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR298598OtherOMAP
OR119011Medicare ID - Type Unspecified