Healthcare Provider Details

I. General information

NPI: 1952189276
Provider Name (Legal Business Name): MITCHELL DAVID WEST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 NE GREENWOOD AVE STE 205
BEND OR
97701-4632
US

IV. Provider business mailing address

354 NE GREENWOOD AVE STE 205
BEND OR
97701-4632
US

V. Phone/Fax

Practice location:
  • Phone: 458-600-8924
  • Fax:
Mailing address:
  • Phone: 458-600-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberR12272
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: