Healthcare Provider Details

I. General information

NPI: 1346549656
Provider Name (Legal Business Name): KATHRYN MEZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WILLOW BEND WAY
CENTRAL POINT OR
97502-8606
US

IV. Provider business mailing address

325 WILLOW BEND WAY
CENTRAL POINT OR
97502-8606
US

V. Phone/Fax

Practice location:
  • Phone: 458-220-7230
  • Fax: 458-299-8416
Mailing address:
  • Phone: 541-858-8170
  • Fax: 458-299-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL17314
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: