Provider Demographics
NPI:1023747458
Name:MUTHAURA, KENETH MUTUMA (CADC -R)
Entity type:Individual
Prefix:MR
First Name:KENETH
Middle Name:MUTUMA
Last Name:MUTHAURA
Suffix:
Gender:M
Credentials:CADC -R
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 STE A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7900
Mailing Address - Country:US
Mailing Address - Phone:541-393-0777
Mailing Address - Fax:541-687-9279
Practice Address - Street 1:78 CENTENNIAL LOOP STE A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7900
Practice Address - Country:US
Practice Address - Phone:541-393-0777
Practice Address - Fax:541-687-9279
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-22-1651101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)