Provider Demographics
NPI:1134623960
Name:BECKY GATHERCOAL COUNSELING INC.
Entity type:Organization
Organization Name:BECKY GATHERCOAL COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:JANELLE
Authorized Official - Last Name:GATHERCOAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-772-8680
Mailing Address - Street 1:1512 NORDIC CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5299
Mailing Address - Country:US
Mailing Address - Phone:541-840-7775
Mailing Address - Fax:541-500-1818
Practice Address - Street 1:3550 NATIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-772-8680
Practice Address - Fax:541-500-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2674251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1063614162OtherNPI