Provider Demographics
NPI:1538986971
Name:BARENO, TABITHA (NBC-HWC)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:BARENO
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MOUNTAIN VIEW PL
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-4612
Mailing Address - Country:US
Mailing Address - Phone:971-713-8094
Mailing Address - Fax:
Practice Address - Street 1:324 MOUNTAIN VIEW PL
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-4612
Practice Address - Country:US
Practice Address - Phone:971-713-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3948899171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty