Organization
SOUTHERN OREGON CBT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KACY MULLEN PHD (OWNER)
(541) 500-8655
Entity
Organization
Contact information
Practice address
235 W MAIN ST, JACKSONVILLE, OR 97530-9278
(541) 204-4933
(800) 433-1396
Mailing address
PO BOX 4752, MEDFORD, OR 97501-0197
(541) 500-8655
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
08/07/2020
Last updated
10/29/2024
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