Provider Demographics
NPI:1356439269
Name:WOODRING, GARY WILLIAM (MA MFT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WILLIAM
Last Name:WOODRING
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W RAPP RD
Mailing Address - Street 2:#72
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9687
Mailing Address - Country:US
Mailing Address - Phone:541-535-8542
Mailing Address - Fax:541-535-4056
Practice Address - Street 1:724 CARDLEY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-941-8989
Practice Address - Fax:541-535-4056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10OtherMFT