Individual
CANDICE PHYLLIS LOVE SHIDLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
2210 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6418
(541) 883-1030
Mailing address
2210 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6418
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/07/2018
Last updated
09/07/2018
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