Provider Demographics
NPI:1255792560
Name:LABHART, BRENT
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:LABHART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3587 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:503-206-8645
Mailing Address - Fax:
Practice Address - Street 1:17720 NE HALSEY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024
Practice Address - Country:US
Practice Address - Phone:503-654-7654
Practice Address - Fax:503-654-7333
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health