Provider Demographics
NPI:1306315957
Name:TAUBER, ANSEL OLIVER
Entity type:Individual
Prefix:
First Name:ANSEL
Middle Name:OLIVER
Last Name:TAUBER
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:CATHERINE
Other - Last Name:TAUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1750 NEBRASKA AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5700
Mailing Address - Country:US
Mailing Address - Phone:541-956-4943
Mailing Address - Fax:
Practice Address - Street 1:2020 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2041
Practice Address - Country:US
Practice Address - Phone:541-267-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR23-QMHPC-001268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health