Healthcare Provider Details

I. General information

NPI: 1144745027
Provider Name (Legal Business Name): HEATHER SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 NE 4TH ST
BEND OR
97701-4200
US

IV. Provider business mailing address

7515 FALCON CREST DR # 200
REDMOND OR
97756-5014
US

V. Phone/Fax

Practice location:
  • Phone: 541-625-4327
  • Fax:
Mailing address:
  • Phone: 541-904-5216
  • Fax: 541-527-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1971
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: