Provider Demographics
NPI:1922317296
Name:EUBANK, ERIC LANE
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LANE
Last Name:EUBANK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LANE
Other - Middle Name:
Other - Last Name:EUBANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1631 NE BROADWAY ST # 107
Mailing Address - Street 2:USE EMAIL OR PHONE FOR CORRESPONDENCE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1425
Mailing Address - Country:US
Mailing Address - Phone:971-351-0492
Mailing Address - Fax:
Practice Address - Street 1:250 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1760
Practice Address - Country:US
Practice Address - Phone:800-342-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical