# HEADWATERS THERAPY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538793591
- **Authorized official:** MR. RYAN S SMITH M.ED, LMFT (LICENSED MARRIAGE & FAMILY THERAPIS)
- **Authorized official phone:** (541) 868-2004

## Contact information

- **Practice address:** 927 COUNTRY CLUB RD STE 200, EUGENE, OR 97401-2272
- **Practice address phone:** (541) 604-8822
- **Practice address fax:** (541) 359-1134
- **Mailing address:** 927 COUNTRY CLUB RD STE 200, EUGENE, OR 97401-2272
- **Mailing address phone:** (541) 604-8822
- **Mailing address fax:** (541) 359-1134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 02/28/2020
- **Last updated:** 06/25/2020