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General NPI Number Information
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NPI Number | 1992453245
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Entity Type | Organization
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Legal Business Name | ORACLE OAK FAMILY THERAPY
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 353 PARK MARINA CIR
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City | REDDING
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State | CA
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Zip | 96001-0965
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Country | US
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Telephone | 530-355-0115
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Fax | 530-245-0992
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Provider Business Mailing Address
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Address Line | 353 PARK MARINA CIR
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City | REDDING
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State | CA
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Zip | 96001-0965
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Country | US
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Telephone | 530-355-0115
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Fax | 530-245-0992
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Authorized Official
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Title or Position | LMFT/PRESIDENT
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Name | JENNI RENE GORDON
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Credential | MA, LMFT
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Telephone | 530-355-0115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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