Healthcare Provider Details

I. General information

NPI: 1366357378
Provider Name (Legal Business Name): HIGH MESA COUNSELING & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 NW GREENWOOD AVE STE 130
BEND OR
97703-2298
US

IV. Provider business mailing address

40 NW GREENWOOD AVE STE 130
BEND OR
97703-2298
US

V. Phone/Fax

Practice location:
  • Phone: 541-903-0446
  • Fax:
Mailing address:
  • Phone: 541-903-0446
  • 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: WHITNEY BLACKHAM
Title or Position: OWNER
Credential: LPC
Phone: 541-903-0446