Healthcare Provider Details

I. General information

NPI: 1225289622
Provider Name (Legal Business Name): GREGORY WAYNE RICH M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E JACKSON ST
MEDFORD OR
97504-6713
US

IV. Provider business mailing address

42 LOGAN WAY
TALENT OR
97540-5608
US

V. Phone/Fax

Practice location:
  • Phone: 541-245-2787
  • Fax: 541-899-3243
Mailing address:
  • Phone: 541-944-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0677
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: