Healthcare Provider Details

I. General information

NPI: 1326784927
Provider Name (Legal Business Name): ANDREW SCOTT DEFRANCE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E JACKSON ST
MEDFORD OR
97504-6713
US

IV. Provider business mailing address

815 E JACKSON ST
MEDFORD OR
97504-6713
US

V. Phone/Fax

Practice location:
  • Phone: 541-245-2787
  • Fax: 541-201-8103
Mailing address:
  • Phone: 541-245-2787
  • Fax: 541-201-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT3205
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: