Provider Demographics
NPI:1386002897
Name:WOODHOUSE, ROBERT H (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:WOODHOUSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 EAST MAIN STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-779-1282
Mailing Address - Fax:541-608-2888
Practice Address - Street 1:1025 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-858-8170
Practice Address - Fax:541-858-8167
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL80231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical