Provider Information for 1912311010
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GINA M MUMEY MSW, RBSW, LCSW
Sex: Female
NPI: 1912311010
Last Updated: 2021-02-08
Certification Date: 2021-02-08
Certification Date: 2021-02-08
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1912311010 | ||||||||||||
| Enumeration Date | 2014-06-17 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1401 N 10TH AVE STAYTON, OR 97383-1399 United States Phone: 502-769-2175 | Fax: | ||||||||||||
| Primary Practice Address | 1401 N 10TH AVE STAYTON, OR 97383-1399 United States Phone: 502-769-2175 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 10373 NE HANCOCK ST 530 WELCH ST | ||||||||||||
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