Provider Demographics
NPI:1578624193
Name:JAN SCOTT GARLOCK PMHNP PC
Entity Type:Organization
Organization Name:JAN SCOTT GARLOCK PMHNP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GARLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:541-772-5992
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR086006628N6101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty