Provider Demographics
NPI:1689011249
Name:BONES, VICTORIA MOHR (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MOHR
Last Name:BONES
Suffix:
Gender:F
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:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0036
Mailing Address - Country:US
Mailing Address - Phone:541-301-0609
Mailing Address - Fax:541-734-4942
Practice Address - Street 1:916 W 10TH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3018
Practice Address - Country:US
Practice Address - Phone:541-301-0609
Practice Address - Fax:541-734-4942
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL2634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health