Individual
NICKEY R FOSSETT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
1017 ARTHUR ST, EUGENE, OR 97402
(541) 636-6180
Mailing address
2045 SE HAWTHORNE BLVD, PORTLAND, OR 97214-3819
(541) 636-6180
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
T1020
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500679774
—
OR
Enumeration date
02/25/2014
Last updated
04/19/2016
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