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General NPI Number Information
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NPI Number | 1285935163
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Entity Type | Organization
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Legal Business Name | DR. E. ALA SHAVANA FINEBERG, LLC
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 124 SW H ST STE 4
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City | GRANTS PASS
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State | OR
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Zip | 97526-2500
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Country | US
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Telephone | 541-846-0590
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 474
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City | WILLIAMS
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State | OR
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Zip | 97544-0474
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Country | US
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Telephone | 541-846-0590
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELLEN JOAN FINEBERG
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Credential | PH.D.
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Telephone | 541-846-0590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1698
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License Number State | OR
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