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General NPI Number Information
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NPI Number | 1104785401
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Entity Type | Individual
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Provider Name | MRS. AMY JEAN DOUGLAS
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Gender | Female
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 1175 E MAIN ST
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City | MEDFORD
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State | OR
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Zip | 97504-7499
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Country | US
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Telephone | 458-488-1250
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Fax | 458-488-1252
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Provider Business Mailing Address
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Address Line | 180 MANZANITA DR
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City | SHADY COVE
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State | OR
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Zip | 97539-0150
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Country | US
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Telephone | 928-846-5976
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Fax | 458-488-1252
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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