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328 S Central Ave Medford OR 97501-7274 | |
| (541) 821-9559 | |
| (541) 702-1236 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 328 S Central Ave, Medford, Oregon |
| Authorized Official Name and Position | Jennifer M Henderson (OWNER) |
| Authorized Official Contact | 5418219559 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 8097 Medford OR 97501-0997 Ph: (541) 821-9559 | 328 S Central Ave Medford OR 97501-7274 Ph: (541) 821-9559 |
| NPI Number | 1962914432 |
|---|---|
| Provider Enumeration Date | 10/24/2017 |
| Last Update Date | 10/24/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962914432 | NPI | - | NPPES |
| 1962675249 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | C2672 (Oregon) | Primary |
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