Healthcare Provider Details

I. General information

NPI: 1417238965
Provider Name (Legal Business Name): TABITHA ARIANN HARRELSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 COBURG RD
EUGENE OR
97401-4966
US

IV. Provider business mailing address

2222 COBURG RD
EUGENE OR
97401-4966
US

V. Phone/Fax

Practice location:
  • Phone: 458-261-9824
  • Fax:
Mailing address:
  • Phone: 458-261-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC3652
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: