Basic Information
| Provider Information | |||||||||
| NPI: | 1245681402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARIOS | ||||||||
| FirstName: | ANDRES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 E 19TH AVE | ||||||||
| Address2: | APT. #7 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974031457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019892889 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1345 BIRCH AVE | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974241416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419423939 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2016 | ||||||||
| LastUpdateDate: | 06/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.