Healthcare Provider Details

I. General information

NPI: 1841116126
Provider Name (Legal Business Name): NATALIE CHISHOLM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SE DIVISION ST STE 1
BEND OR
97702-1250
US

IV. Provider business mailing address

1180 SE DIVISION ST STE 1
BEND OR
97702-1250
US

V. Phone/Fax

Practice location:
  • Phone: 541-229-8861
  • Fax: 541-314-9456
Mailing address:
  • Phone: 541-229-8861
  • Fax: 541-314-9456

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:
Title or Position:
Credential:
Phone: