Provider Demographics
NPI:1720823842
Name:CHURCH, KATHRYN E
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:CHURCH
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 1:949 NW MADRAS HWY
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1457
Mailing Address - Country:US
Mailing Address - Phone:541-972-0718
Mailing Address - Fax:
Practice Address - Street 1:949 NW MADRAS HWY
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1457
Practice Address - Country:US
Practice Address - Phone:541-972-0718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health