Healthcare Provider Details

I. General information

NPI: 1083957690
Provider Name (Legal Business Name): CHRISTINE MICHEL EWING M.S. COUNSELING, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 NW FRANKLIN AVE # 107
BEND OR
97703-2752
US

IV. Provider business mailing address

20484 MAZAMA PL
BEND OR
97702-9809
US

V. Phone/Fax

Practice location:
  • Phone: 541-306-1128
  • Fax:
Mailing address:
  • Phone: 909-576-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT1189
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number66335
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1189
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: