Provider Demographics
NPI:1871029165
Name:MANABE, KIYOMI
Entity Type:Individual
Prefix:
First Name:KIYOMI
Middle Name:
Last Name:MANABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 CENTENNIAL LOOP
Mailing Address - Street 2:STE A
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7909
Mailing Address - Country:US
Mailing Address - Phone:503-956-3436
Mailing Address - Fax:
Practice Address - Street 1:78 CENTENNIAL LOOP
Practice Address - Street 2:STE A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7909
Practice Address - Country:US
Practice Address - Phone:503-956-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)