Individual
MRS. DIANE GALE TIBBITTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
720 CARDLEY AVE, MEDFORD, OR 97504-6124
(541) 772-7068
Mailing address
720 CARDLEY AVE, MEDFORD, OR 97504-6124
(541) 772-7068
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CO851
OR
Other
Enumeration date
10/04/2010
Last updated
10/04/2010
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