Individual
JANETTE FAY MYDLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, C10678
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 440-3532
Mailing address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 440-3532
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
OR
101YM0800X
Mental Health Counselor
LPC-1293
WY
101YM0800X
Mental Health Counselor
LPC-2465
WY
101YM0800X
Mental Health Counselor
QMHPC-001646
OR
101YP2500X
Professional Counselor
Primary
C10678
OR
101YP2500X
Professional Counselor
LPC-1293
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5000863088
—
OR
Enumeration date
10/02/2009
Last updated
02/26/2026
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