1699837674 NPI number — MS. ESTHER FLORENCE GOLDBERG LPC

Table of content: MS. ESTHER FLORENCE GOLDBERG LPC (NPI 1699837674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699837674 NPI number — MS. ESTHER FLORENCE GOLDBERG LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDBERG
Provider First Name:
ESTHER
Provider Middle Name:
FLORENCE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699837674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
487 WALNUT ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97520-1535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-326-1454
Provider Business Mailing Address Fax Number:
541-857-9883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
531 NE 'E' ST.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-326-1454
Provider Business Practice Location Address Fax Number:
541-857-9883
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C1270 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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