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BRODERICK R STATES
NPI 1073178794
Counselor - Mental Health in Medford, OR

Active since May 08, 2019
3200 JUANIPERO WAY, MEDFORD, OR 97504(541) 816-4131(458) 226-2163 Get Directions Write a Review

NPPES record last updated: May 8, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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
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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.

JENNIFER LYNN BURNETT CASTILLO
Counselor (Mental Health)
3200 JUANIPERO WAY
MEDFORD, OR 97504
Jackson County (541) 816-4131
COLUMBIACARE SERVICES
Clinic/Center
3200 JUANIPERO WAY
MEDFORD, OR 97504
Jackson County (541) 858-8170
KARRYN DANIELLE OLSON
Counselor (Mental Health)
3200 JUANIPERO WAY
MEDFORD, OR 97504
Jackson County (541) 816-4131
JUSTINE JEWEL COMPOMIZZI
Counselor (Mental Health)
3200 JUANIPERO WAY
MEDFORD, OR 97504
Jackson County (541) 816-4131
MIZUKO TAKAMOTO
Massage Therapist
3200 JUANIPERO WAY
MEDFORD, OR 97504
Jackson County (541) 816-4131
SARAH DEWOLF
Counselor (Mental Health)
3200 JUANIPERO WAY
MEDFORD, OR 97504
Jackson County (541) 816-4131
MIRANDA J HEDGPETH
Counselor (Mental Health)
3200 JUANIPERO WAY
MEDFORD, OR 97504
Jackson County (541) 816-4131
JUAN JUBENTINO CONCHAS
Counselor (Mental Health)
3200 JUANIPERO WAY
MEDFORD, OR 97504
Jackson County (541) 816-4131

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Broderick States's NPI number?

The NPI number for Broderick States is 1073178794. It was assigned to this individual provider in the NPPES registry on May 8, 2019.

Where is Broderick States located?

Broderick States practices at 3200 Juanipero Way, Medford, OR 97504. The listed phone number is (541) 816-4131.

What is Broderick States's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Broderick States was last updated on May 8, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.