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NPI Code Detail

MEDICARE: MIA REESE VANDERVER

MEDICARE: MIA REESE VANDERVER
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1942138656
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIA REESE VANDERVER
Provider Business Mailing Address
First Line : 2577 NE COURTNEY DR
Second Line :
City : BEND
State : OR
Zip : 97701-7752
Country : US
Telephone Number : 541-322-7500
Fax Number : 541-322-7565
Provider Business Practice Location Address
First Line : 2577 NE COURTNEY DR
Second Line :
City : BEND
State : OR
Zip : 97701-7752
Country : US
Telephone Number : 541-322-7500
Fax Number : 541-322-7565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

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Directions to “ MIA REESE VANDERVER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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