Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003368564 |
---|---|
Provider Name | Bethany Tournade |
First Address | Eugene, OR 97402 |
Second Address | Eugene, OR 97408-1791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2016 |
Last Update Date | 18/08/2017 |