Healthcare Provider Details

I. General information

NPI: 1083546055
Provider Name (Legal Business Name): MIKAELA GRAHAM MCOUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKAELA PETERS

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 NE DIVISION ST STE 101
BEND OR
97703-3551
US

IV. Provider business mailing address

2155 NE 6TH ST APT 97
BEND OR
97701-3874
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-3109
  • Fax:
Mailing address:
  • Phone: 541-797-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: