Provider Demographics
NPI:1649645151
Name:JACKSON COUNTY COMMUNITY JUSTICE
Entity type:Organization
Organization Name:JACKSON COUNTY COMMUNITY JUSTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-774-4812
Mailing Address - Street 1:609 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3106
Mailing Address - Country:US
Mailing Address - Phone:541-774-4812
Mailing Address - Fax:541-774-4888
Practice Address - Street 1:609 W 10TH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3106
Practice Address - Country:US
Practice Address - Phone:541-774-4812
Practice Address - Fax:541-774-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty