Provider Demographics
NPI:1497292718
Name:METHENY, KIMBERLY JUNE (CSWA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JUNE
Last Name:METHENY
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JUNE
Other - Last Name:HUMISTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:891 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-1229
Mailing Address - Country:US
Mailing Address - Phone:916-846-0763
Mailing Address - Fax:
Practice Address - Street 1:1776 MILLRACE DR STE 202
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-2536
Practice Address - Country:US
Practice Address - Phone:541-357-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA113581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical