Provider Demographics
NPI:1396008512
Name:PRUCH, JOSEPHINE CASEY WITTE (MED, LMFT)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:CASEY WITTE
Last Name:PRUCH
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:CASEY
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LMFT
Mailing Address - Street 1:3022 ONYX PL
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3575 DONALD ST
Practice Address - Street 2:SUITE #105
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4753
Practice Address - Country:US
Practice Address - Phone:541-203-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor