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General NPI Number Information
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NPI Number | 1134623960
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Entity Type | Organization
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Legal Business Name | BECKY GATHERCOAL COUNSELING INC.
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 3550 NATIONAL DRIVE
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City | MEDFORD
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State | OR
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Zip | 97504
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Country | US
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Telephone | 541-772-8680
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Fax | 541-500-1818
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Provider Business Mailing Address
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Address Line | 1512 NORDIC CT
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City | MEDFORD
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State | OR
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Zip | 97504-5299
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Country | US
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Telephone | 541-840-7775
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Fax | 541-500-1818
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | MRS. BECKY JANELLE GATHERCOAL
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Credential | LCSW
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Telephone | 541-772-8680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2674
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License Number State | OR
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