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NPI Code Detail

MEDICARE: JAMES EUBANKS MFT

MEDICARE: JAMES EUBANKS MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist
2106H00000XMarriage & Family Therapist124393CA

General Provider Information

NPI Number : 1023417375
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES EUBANKS MFT
Provider Business Mailing Address
First Line : 444 N WASHINGTON ST
Second Line :
City : CLOVERDALE
State : CA
Zip : 95425-3237
Country : US
Telephone Number : 707-616-4578
Fax Number :
Provider Business Practice Location Address
First Line : 1955 CLEVELAND AVE STE 205
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4282
Country : US
Telephone Number : 707-723-2570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2014
Last Update Date : 02/06/2024

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