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Organization
WOMEN'S MENTAL HEALTH OF SOUTHERN OREGON
Active
Organization
WOMEN'S MENTAL HEALTH OF SOUTHERN OREGON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE GREEN LPC (OWNER)
(541) 840-5926
Entity
Organization
Contact information
Practice address
33 N CENTRAL AVE STE 409, MEDFORD, OR 97501-5939
(541) 840-5926
Mailing address
33 N CENTRAL AVE STE 409, MEDFORD, OR 97501-5939
(541) 840-5926
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C4548
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144638255
—
OR
Enumeration date
07/05/2017
Last updated
07/21/2022
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