| Juvenile Division Cbt Program | |
|
609 W 10th St Medford OR 97501-3106 | |
| (541) 774-4812 | |
| (541) 774-4888 |
| Full Name | Juvenile Division Cbt Program |
|---|---|
| Speciality | Counselor |
| Location | 609 W 10th St, Medford, Oregon |
| Authorized Official Name and Position | Donald Scott Mickey (SUPERVISOR) |
| Authorized Official Contact | 5417744812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Juvenile Division Cbt Program 609 W 10th St Medford OR 97501-3106 Ph: (541) 774-4812 | Juvenile Division Cbt Program 609 W 10th St Medford OR 97501-3106 Ph: (541) 774-4812 |
| NPI Number | 1649645151 |
|---|---|
| Provider Enumeration Date | 12/09/2015 |
| Last Update Date | 12/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649645151 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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