Basic Information
| Provider Information | |||||||||
| NPI: | 1205572146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORICHAR | ||||||||
| FirstName: | TEA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2940 CRESCENT AVE UNIT 217 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974087405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023708112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 37875 JASPER LOWELL RD | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974389751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417471235 | ||||||||
| FaxNumber: | 5417474722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2022 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.