Provider Demographics
NPI:1043461239
Name:EBERHARDT, ROXANNE LAUREN
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:LAUREN
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 HUMBOLDT RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9196
Mailing Address - Country:US
Mailing Address - Phone:530-570-7180
Mailing Address - Fax:
Practice Address - Street 1:1530 HUMBOLDT RD STE 4
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9196
Practice Address - Country:US
Practice Address - Phone:530-570-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist