Healthcare Provider Details

I. General information

NPI: 1477757474
Provider Name (Legal Business Name): ROBERT LEWIS NUTTING, MSW, LCSW, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D'ANJOU BUILDING (NOT A MAILIING ADDRESS) 328 SOUTH CENTRAL AVENUE
MEDFORD OR
97501
US

IV. Provider business mailing address

PO BOX 302
MURPHY OR
97533-0302
US

V. Phone/Fax

Practice location:
  • Phone: 541-500-8655
  • Fax:
Mailing address:
  • Phone: 541-500-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13466
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL5127
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: