Individual provider · Type 1 NPI

Broderick R. States

Mental Health Counselor · Medford, OR

NPI number 1073178794 Active

Practice location

3200 Juanipero Way
Medford, OR 97504

Call (541) 816-4131 Map

Fax (458) 226-2163

Mailing address

3587 Heathrow Way
Medford, OR 97504-4004

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1073178794

Broderick R. States's National Provider Identifier is 1073178794, issued on May 8, 2019. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Medford, OR. The record was last updated on May 8, 2019.