SOUTHERN OREGON CBT LLC (NPI# 1306456058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306456058 |
| Entity Type | Organization |
| Organization Name | SOUTHERN OREGON CBT LLC |
| Practice Address |
690 G St Ste C Jacksonville OR 97530-3208 |
| Mailing Address |
Po Box 4752 Medford OR 97501-0197 |
| Practice Telephone | 4933204541 |
| Practice Fax Number | 8004331396 |
| Mailing Telephone | 5415008655 |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2020-09-01 |
| Authorized Official Name | KACY MULLEN (OWNER) |
| Authorized Official Telephone | 5415008655 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Street Address |
690 G ST STE C |
| City | JACKSONVILLE |
| State | OR |
| Zip Code | 97530-3208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083112957 | Cody Moss | Chiropractor | 660 G St Ste A, Jacksonville, OR 97530 | 2018-01-25 |
| 1659819621 | Denise Alane Davis | Nurse Practitioner | 115 Ponderosa Way, Jacksonville, OR 97530 | 2017-02-09 |
| 1831640192 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 8336 Highway 62, White City, OR 97530 | 2016-10-20 |
| 1023444502 | Rebecca Lynne Giudili | Behavioral Analyst | 1425 Humbug Ck Rd, Jacksonville, OR 97530 | 2013-09-17 |
| 1487922381 | Ashley Rose Merrill | Midwife | 235 E. Main St., Jacksonville, OR 97530 | 2011-12-06 |
| 1518135334 | Lynn Ellen Reordan | Physical Therapist | 635 N. 5th St., Jacksonville, OR 97530 | 2008-02-14 |
| 1821289984 | Nathan M Tanner | Dentist | 725 N 5th St Ste 101, Jacksonville, OR 97530 | 2007-08-05 |
| 1467667139 | Diana K Helvey | Denturist | 590 Blackstone Alley, Jacksonville, OR 97530 | 2007-05-14 |
| 1902027295 | Michelle Dawn Bienick | Naprapath | 1881 Humbug Creek Rd, Applegate, OR 97530 | 2007-05-02 |
| 1821121526 | Anne Marie Vincent | Chiropractor | 7370 Hwy 238, Jacksonville, OR 97530 | 2007-03-13 |
| Find all providers in zip 97530 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740224 | North Florida Collaborative Therapy | Psychologist | 9652 Morgan Creek Ct, Jacksonville, FL 32222-5808 | 2020-11-05 |
| 1013408004 | Marisa Victoria Byles | Psychologist | 12443 San Jose Blvd Ste 202, Jacksonville, FL 32223-8648 | 2018-05-24 |
| 1306203245 | Robin Jones | Psychologist | 200 Valencia Dr Ste 194, Jacksonville, NC 28546-6311 | 2016-01-22 |
| 1336510452 | Nour Mahmoud Abdelghani | Psychologist | 524 Skymarks Dr Unit 5, Jacksonville, FL 32218-7254 | 2015-10-15 |
| 1295105823 | Mhealthcare Co. | Psychologist | 3805 Valencia Rd, Jacksonville, FL 32205-9271 | 2015-09-24 |
| 1629406400 | Max Aaron Horovitz | Psychologist | 10475 Centurion Pkwy N Ste 301, Jacksonville, FL 32256-5004 | 2013-10-14 |
| 1457786915 | Coral Gaffney | Psychologist | 6488 103rd St., Ste B, Jacksonville, FL 32210 | 2013-09-03 |
| 1801236542 | Jeffrey Allan Rommel | Psychologist | 11150 Castlemain Cir S, Jacksonville, FL 32256-4825 | 2013-06-26 |
| 1326483017 | Amy Melinda Hartley | Psychologist | 8355 Merchants Gate Dr, Jacksonville, FL 32222-5848 | 2013-05-08 |
| 1790040020 | Maria R. Tapia | Psychologist | 7680 Smullian Trail West, Jacksonville, FL 32217 | 2012-07-12 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 97530 |
Please comment or provide details below to improve the information on SOUTHERN OREGON CBT LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.