Favreau, Tom
Favreau, Tom is an individual health care provider with primary practice located at 410 N 9Th St , Cottage Grove OR 97424-1307. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Favreau, Tom can be contacted via phone (541) 942-2850.Contact Information
Primary practice address
410 N 9Th St
Cottage Grove OR 97424-1307
Phone: (541) 942-2850
Fax: (541) 942-1574
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X |
Profile Details
| NPI number | 1306997481 |
|---|---|
| LBN Legal business name | Favreau, Tom |
| Credentials | QMHP, MA |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 15th, 2007 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306997481 | NPPES |
| Oregon | MEDICAID | 019047 |
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