Healthcare Provider Details

I. General information

NPI: 1750258851
Provider Name (Legal Business Name): FRIENDS OF THE CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21136 COPPERFIELD AVE
BEND OR
97702-1888
US

IV. Provider business mailing address

21136 COPPERFIELD AVE
BEND OR
97702-1888
US

V. Phone/Fax

Practice location:
  • Phone: 619-918-2006
  • Fax: 619-918-2006
Mailing address:
  • Phone: 619-918-2006
  • Fax: 619-918-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MATHEU JAMES ISLAS
Title or Position: PROFESSIONAL MENTOR
Credential:
Phone: 619-918-2006