Healthcare Provider Details

I. General information

NPI: 1932674025
Provider Name (Legal Business Name): ELIZABETH HADDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SW CENTURY DR STE 100
BEND OR
97702-3558
US

IV. Provider business mailing address

PO BOX 1321
FLAGSTAFF AZ
86002-1321
US

V. Phone/Fax

Practice location:
  • Phone: 458-899-5016
  • Fax: 458-200-4591
Mailing address:
  • Phone: 458-899-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR8530
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: