Provider Demographics
NPI:1629375134
Name:RASCON, LIBBIE DAWNN
Entity Type:Individual
Prefix:
First Name:LIBBIE
Middle Name:DAWNN
Last Name:RASCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIBBIE
Other - Middle Name:DAWNN
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3535
Mailing Address - Country:US
Mailing Address - Phone:541-607-7020
Mailing Address - Fax:541-607-7020
Practice Address - Street 1:99 W 10TH AVE STE 117
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3051
Practice Address - Country:US
Practice Address - Phone:541-607-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORTHW00018175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist