BRODERICK R STATES
NPI 1073178794
Counselor - Mental Health in Medford, OR
Active since May 08, 2019
About Broderick R States NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BRODERICK R STATES (NPI 1073178794) is an individual mental health provider in Medford, Oregon and active in the NPI registry since May 2019.
NPPES Registry Identity
NPI1073178794
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameBRODERICK R STATES
Location Address3200 JUANIPERO WAYMedford, OR 97504
Mailing Address3587 Heathrow WayMedford, OR 97504-4004 · (541) 858-8170 · Fax (541) 858-8167
Phone(541) 816-4131
Fax(458) 226-2163
Sole ProprietorNo
Enumeration DateMay 8, 2019
✔ NPI 1073178794 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
3200 JUANIPERO WAY, Medford, OR 97504
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1073178794, enumerated as an "individual" on May 08, 2019.
The provider is located at 3200 JUANIPERO WAY MEDFORD, OR 97504 and the phone number is (541) 816-4131.
Counselor with taxonomy code 101YM0800X and a focus in Mental Health.
