MEDICARE: CASEY KOHL LCSW LLC DBA MID-VALLEY MINDFULNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1730021791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASEY KOHL LCSW LLC DBA MID-VALLEY MINDFULNESS

Provider Business Mailing Address
First Line	:	1701 W HARVARD AVE # 204
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-2716
Country	:	US
Telephone Number	:	459-280-9031
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 W HARVARD AVE # 204
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-2716
Country	:	US
Telephone Number	:	458-280-9031
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CASEY KOHL
Credential	:	LCSW
Telephone Number	:	458-280-9031

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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