Healthcare Provider Details

I. General information

NPI: 1215647557
Provider Name (Legal Business Name): AMANDA DARLENE ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NW OREGON AVE STE 202
BEND OR
97703-2745
US

IV. Provider business mailing address

220 NW OREGON AVE STE 202
BEND OR
97703-2745
US

V. Phone/Fax

Practice location:
  • Phone: 541-846-8173
  • Fax: 541-919-2744
Mailing address:
  • Phone: 541-846-8173
  • Fax: 541-919-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9848
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: