Provider Demographics
NPI:1578539391
Name:BOEVE, KATHLEEN RAE (LCSW PHD)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RAE
Last Name:BOEVE
Suffix:
Gender:F
Credentials:LCSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 973
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:503-472-1959
Mailing Address - Fax:503-435-1475
Practice Address - Street 1:117 NW 8TH STREET
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-472-1959
Practice Address - Fax:503-435-1475
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000TLCVTMedicare PIN