Provider Demographics
NPI:1710471974
Name:BOOTES, KATHLEEN JUNE (QMHP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JUNE
Last Name:BOOTES
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JUNE
Other - Last Name:MARROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 35TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-5865
Mailing Address - Country:US
Mailing Address - Phone:541-225-8800
Mailing Address - Fax:
Practice Address - Street 1:2145 CENTENNIAL PLZ
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2421
Practice Address - Country:US
Practice Address - Phone:541-485-6340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health