Provider Demographics
NPI:1215138987
Name:KIM-FUCHS, ANN (BA)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:KIM-FUCHS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2411 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5824
Mailing Address - Country:US
Mailing Address - Phone:541-682-3608
Mailing Address - Fax:541-682-9889
Practice Address - Street 1:2411 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5824
Practice Address - Country:US
Practice Address - Phone:541-682-3608
Practice Address - Fax:541-682-9889
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1215138987Medicaid