Healthcare Provider Details

I. General information

NPI: 1306758859
Provider Name (Legal Business Name): KINMBERLY MARNAY ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN ST STE 4E
MEDFORD OR
97501-2744
US

IV. Provider business mailing address

201 W MAIN ST STE 4E
MEDFORD OR
97501-2744
US

V. Phone/Fax

Practice location:
  • Phone: 541-281-9026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: