Healthcare Provider Details

I. General information

NPI: 1689228751
Provider Name (Legal Business Name): KIMBERLY ANNE BROWN CADC II , QMHA-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2019
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 OAK ST
EUGENE OR
97401-3132
US

IV. Provider business mailing address

78 CENTENNIAL LOOP STE A
EUGENE OR
97401-7900
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-6987
  • Fax:
Mailing address:
  • Phone: 541-393-0777
  • Fax: 541-687-9279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19-R-20
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20-QMHA-R-0164
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier19-R-20
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: