MEDICARE: MARYAM MIRAHMADI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1801571260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAM MIRAHMADI

Provider Business Mailing Address
First Line	:	431 NW FRANKLIN AVE STE 200
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2827
Country	:	US
Telephone Number	:	541-834-9068
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 NW FRANKLIN AVE STE 200
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2827
Country	:	US
Telephone Number	:	541-834-9068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2023
Last Update Date	:	11/04/2025

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Directions to “ MARYAM MIRAHMADI ” Practice Location

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