Healthcare Provider Details

I. General information

NPI: 1821914912
Provider Name (Legal Business Name): ELIZABETH T HASLOB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 WILLAMETTE ST STE 201&202
EUGENE OR
97405-3170
US

IV. Provider business mailing address

65 HATTON AVE APT 104
EUGENE OR
97404-6806
US

V. Phone/Fax

Practice location:
  • Phone: 541-234-3090
  • Fax: 541-735-9480
Mailing address:
  • Phone: 601-826-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: