Healthcare Provider Details

I. General information

NPI: 1912843236
Provider Name (Legal Business Name): ERIN FAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 MERRIMAN RD
MEDFORD OR
97501-1260
US

IV. Provider business mailing address

1750 NEBRASKA AVE BLDG A
GRANTS PASS OR
97527-5700
US

V. Phone/Fax

Practice location:
  • Phone: 541-237-0053
  • Fax: 541-200-3450
Mailing address:
  • Phone: 541-244-8557
  • Fax: 541-244-8557

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: