Provider Demographics
NPI:1790461317
Name:PANGBORN, REBECCA (QMHA-R)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PANGBORN
Suffix:
Gender:F
Credentials:QMHA-R
Other - Prefix:
Other - First Name:BECCA
Other - Middle Name:
Other - Last Name:PANGBORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3260 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6265
Mailing Address - Country:US
Mailing Address - Phone:408-891-3287
Mailing Address - Fax:
Practice Address - Street 1:2650 SUZANNE WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7319
Practice Address - Country:US
Practice Address - Phone:408-891-3287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling