1396008512 NPI number — JOSEPHINE CASEY WITTE PRUCH M.ED., LMFT

Table of content: JOSEPHINE CASEY WITTE PRUCH M.ED., LMFT (NPI 1396008512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396008512 NPI number — JOSEPHINE CASEY WITTE PRUCH M.ED., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRUCH
Provider First Name:
JOSEPHINE
Provider Middle Name:
CASEY WITTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WITTE
Provider Other First Name:
JOSEPHINE
Provider Other Middle Name:
CASEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396008512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3022 ONYX PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97405-4261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3575 DONALD ST
Provider Second Line Business Practice Location Address:
SUITE #105
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97405-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-203-3876
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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