Provider Demographics
NPI:1679693956
Name:ELIGIAN, GREGORY K (MS PA)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:K
Last Name:ELIGIAN
Suffix:
Gender:M
Credentials:MS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 W 12TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-344-8701
Mailing Address - Fax:
Practice Address - Street 1:292 W 12TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-344-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical