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Kavya Mudiam
Mental Health Counselor in Coburg, Oregon
NPI 1508521733

Kavya Mudiam is a Mental Health Counselor based in Coburg, OR and is specialized in Mental Health. Kavya Mudiam practices in Coburg, OR. The NPI Number for Kavya Mudiam is 1508521733 and holds a License No. (Oregon).

The current practice location address for Kavya Mudiam is 1 Serenity Ln, Coburg, OR and can be reached out via phone at 615-663-0773.

Location: 1 Serenity Ln, Coburg, OR, 97408-9350
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1508521733
Provider Name
Kavya Mudiam
Credential
Provider Entity Type
Individual
Gender
Female
Address
1 Serenity Ln, Coburg, OR, 97408-9350
Phone Number
615-663-0773
Fax Number
Provider Enumeration Date
11/02/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1 Serenity Ln
City
Coburg
State
Oregon
Zip
97408-9350
Phone Number
615-663-0773
Fax Number
person
Provider Business Mailing Address Details
Address
1 Serenity Ln
City
Coburg
State
Oregon
Zip
97408-9350
Phone Number
615-663-0773
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
21-QMHA-R-1774 (Oregon)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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