Healthcare Provider Details

I. General information

NPI: 1154445708
Provider Name (Legal Business Name): ALETA BAUCUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 COBURG RD
EUGENE OR
97401-4949
US

IV. Provider business mailing address

26609 PICKENS RD
EUGENE OR
97402-9282
US

V. Phone/Fax

Practice location:
  • Phone: 541-726-3990
  • Fax: 541-736-7279
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: