Healthcare Provider Details

I. General information

NPI: 1619693041
Provider Name (Legal Business Name): KRISTINA PESCATORE LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 N HWY 97
BEND OR
97703-7559
US

IV. Provider business mailing address

PO BOX 1041
BEND OR
97709-1041
US

V. Phone/Fax

Practice location:
  • Phone: 541-205-9290
  • Fax: 541-610-1692
Mailing address:
  • Phone: 541-205-9290
  • Fax: 541-610-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR7960
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: