Healthcare Provider Details

I. General information

NPI: 1508702077
Provider Name (Legal Business Name): CARMEL PARDISSE BUCKINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 NW CROSSING DR
BEND OR
97703-7189
US

IV. Provider business mailing address

14754 SW SCHOLLS FERRY RD APT 1024
BEAVERTON OR
97007-8976
US

V. Phone/Fax

Practice location:
  • Phone: 458-206-0904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR12288
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: