Provider Demographics
NPI:1356615173
Name:KAUFMAN, MICHAEL (MFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:1234 PEARL ST STE 4
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3642
Mailing Address - Country:US
Mailing Address - Phone:541-991-9624
Mailing Address - Fax:
Practice Address - Street 1:1234 PEARL ST STE 4
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-991-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1277106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist