Healthcare Provider Details

I. General information

NPI: 1801466032
Provider Name (Legal Business Name): MATTHEW ALBERT LENZMEIER CRM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 NE 4TH ST
BEND OR
97701-4646
US

IV. Provider business mailing address

2216 NE HOLLIDAY AVE
BEND OR
97701-6033
US

V. Phone/Fax

Practice location:
  • Phone: 541-617-7365
  • Fax:
Mailing address:
  • Phone: 541-213-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-21-580
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number21-CRM-529
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: