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General NPI Number Information
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NPI Number | 1922317296
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Entity Type | Individual
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Provider Name | ERIC LANE EUBANK
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Gender | Male
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 250 PARK ST
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1760
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Country | US
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Telephone | 800-342-2898
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Fax |
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Provider Business Mailing Address
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Address Line | 1631 NE BROADWAY ST # 107 USE EMAIL OR PHONE FOR CORRESPONDENCE
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City | PORTLAND
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State | OR
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Zip | 97232-1425
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Country | US
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Telephone | 971-351-0492
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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