Healthcare Provider Details

I. General information

NPI: 1962203497
Provider Name (Legal Business Name): ELISHA DANIEL MANZANO BILLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ELISHA DANIEL BILLMAN

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37875 JASPER LOWELL RD
JASPER OR
97438-9751
US

IV. Provider business mailing address

37875 JASPER LOWELL RD
JASPER OR
97438-9751
US

V. Phone/Fax

Practice location:
  • Phone: 541-971-0600
  • Fax:
Mailing address:
  • Phone: 541-971-0600
  • 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: