Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southern Oregon CBT LLC

Organization Clinical Psychologist · NPI 1306456058

Southern Oregon CBT LLC is a Clinical Psychologist in Jacksonville, Oregon. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

235 W Main St
Jacksonville, OR 97530-9278
Phone: (541) 204-4933
Fax: (800) 433-1396
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X

Record details

NPI number1306456058
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kacy Mullen — Owner · (541) 500-8655
NPI enumeratedAugust 7, 2020
Last updated in NPPESOctober 29, 2024
Certification dateOctober 29, 2024
Mailing addressPo Box 4752, Medford, OR 97501-0197