Healthcare Provider Details

I. General information

NPI: 1275493090
Provider Name (Legal Business Name): EVAN KAUFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 DONALD ST STE 125
EUGENE OR
97405-4700
US

IV. Provider business mailing address

2385 TYLER ST
EUGENE OR
97405-2160
US

V. Phone/Fax

Practice location:
  • Phone: 541-968-6575
  • Fax:
Mailing address:
  • Phone: 541-968-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR11966
License Number StateOR

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: