Healthcare Provider Details

I. General information

NPI: 1861547796
Provider Name (Legal Business Name): ANDREA GALEN WOODS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 E BARNETT RD
MEDFORD OR
97504-8344
US

IV. Provider business mailing address

100 E MAIN ST SUITE C
MEDFORD OR
97501-6041
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-4238
  • Fax: 541-789-5729
Mailing address:
  • Phone: 541-789-5526
  • Fax: 541-789-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0401
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: