Healthcare Provider Details

I. General information

NPI: 1184296402
Provider Name (Legal Business Name): MS. KIMBERLY LEANN HAWES CARLISLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 HIGH ST
EUGENE OR
97401-3238
US

IV. Provider business mailing address

1258 HIGH ST
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-8437
  • Fax:
Mailing address:
  • Phone: 541-342-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-26-6672
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC10726
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: