Healthcare Provider Details

I. General information

NPI: 1356709984
Provider Name (Legal Business Name): NAAMITH HEIBLUM PH.D., QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SHELTON MCMURPHEY BLVD
EUGENE OR
97401-4928
US

IV. Provider business mailing address

10 SHELTON MCMURPHEY BLVD
EUGENE OR
97401-4928
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-2711
  • Fax: 888-975-0250
Mailing address:
  • Phone: 541-485-2711
  • Fax: 888-975-0250

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:

# 1
Identifier500700319
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: