Provider Demographics
NPI:1861578353
Name:GARLOCK, JAN SCOTT (PMHNP)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:SCOTT
Last Name:GARLOCK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 JUANIPERO WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8640
Mailing Address - Country:US
Mailing Address - Phone:541-772-5992
Mailing Address - Fax:541-772-5996
Practice Address - Street 1:3140 JUANIPERO WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8640
Practice Address - Country:US
Practice Address - Phone:541-772-5992
Practice Address - Fax:541-772-5996
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR086006628N6163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116419Medicare ID - Type Unspecified
ORS33627Medicare UPIN