Healthcare Provider Details

I. General information

NPI: 1194016931
Provider Name (Legal Business Name): RO ZIENTARA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2468 W. 11TH AVE
EUGENE OR
97402-9740
US

IV. Provider business mailing address

2468 W 11TH AVE
EUGENE OR
97402-3314
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4234
  • Fax: 541-484-4583
Mailing address:
  • Phone: 541-484-4234
  • Fax: 541-484-4583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberC4367
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC4367
License Number StateOR

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: