Healthcare Provider Details

I. General information

NPI: 1144651415
Provider Name (Legal Business Name): KAIROS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 TACOMA ST
GRANTS PASS OR
97526-9370
US

IV. Provider business mailing address

210 TACOMA ST
GRANTS PASS OR
97526-9370
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-3302
  • Fax: 541-956-5463
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: JOEL SHIPPY
Title or Position: SKILLS COACH
Credential:
Phone: 541-479-7707