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1124773148
ETHAN DEGHELDER
SPRINGFIELD, OR
NPI
1124773148
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: professionallicense)
Enumeration Date
2022-02-17
Last Update Date
2023-05-16
Business Address
ETHAN DEGHELDER
3825 INTERNATIONAL CT
SPRINGFIELD, OR 97477-1086
Phone number: 541-858-8170
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Mailing Address
ETHAN DEGHELDER
3587 HEATHROW WAY
MEDFORD, OR 97504-4004
Phone number: 541-858-8170
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