Healthcare Provider Details

I. General information

NPI: 1780916692
Provider Name (Legal Business Name): ERIN ELIZABETH KITSELMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 W 11TH AVE SUITE 290
EUGENE OR
97402-3758
US

IV. Provider business mailing address

PO BOX 8024 91229 N. WILLAMETTE ST
COBURG OR
97408-1301
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1262
  • Fax:
Mailing address:
  • Phone: 541-517-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health 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: