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1104382324
TIM BLACK
EUGENE, OR
NPI
1104382324
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
(Licence: professionallicense)
Enumeration Date
2019-02-12
Last Update Date
2022-02-08
Business Address
TIM BLACK
2222 COBURG RD STE 100
EUGENE, OR 97401-4988
Phone number: 458-210-2984
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Mailing Address
TIM BLACK
3587 HEATHROW WAY
MEDFORD, OR 97504-4004
Phone number: 541-858-8170
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