Individual
TIM BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2222 COBURG RD STE 100, EUGENE, OR 97401-4988
(458) 210-2984
(458) 210-2985
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PROFESSIONALLICENSE
—
Other
Enumeration date
02/12/2019
Last updated
02/08/2022
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