Provider Demographics
NPI:1871204644
Name:EICHENSEHER, TASHA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:EICHENSEHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:CO
Mailing Address - Zip Code:80442-0480
Mailing Address - Country:US
Mailing Address - Phone:202-431-6160
Mailing Address - Fax:
Practice Address - Street 1:79050 US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482-5667
Practice Address - Country:US
Practice Address - Phone:202-431-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000000000OtherN/A