Healthcare Provider Details

I. General information

NPI: 1902131352
Provider Name (Legal Business Name): JANETTE FAY MYDLAND MS, QMHPC-001646
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W 5TH ST
SHERIDAN WY
82801
US

IV. Provider business mailing address

1939 NE DIAMOND LAKE BLVD.
ROSEBURG OR
97470
US

V. Phone/Fax

Practice location:
  • Phone: 307-674-4405
  • Fax: 307-673-5167
Mailing address:
  • Phone: 541-957-5646
  • Fax: 307-673-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberQMHPC-001646
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-1293
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: