Healthcare Provider Details

I. General information

NPI: 1053813758
Provider Name (Legal Business Name): JAMIE MYERS CADC I, CRM, PSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE BARTOSZ

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 SE 3RD ST
BEND OR
97702-1754
US

IV. Provider business mailing address

685 SE 3RD ST
BEND OR
97702-1754
US

V. Phone/Fax

Practice location:
  • Phone: 541-617-7365
  • Fax:
Mailing address:
  • Phone: 541-668-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-24-3930
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHA-R-6536
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number17-CRM-235
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: