Healthcare Provider Details

I. General information

NPI: 1699032300
Provider Name (Legal Business Name): CHERIE C SKILLINGS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 12/21/2022
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 NE PROFESSIONAL CT STE 250
BEND OR
97701-6988
US

IV. Provider business mailing address

PO BOX 6832
BEND OR
97708-6832
US

V. Phone/Fax

Practice location:
  • Phone: 541-419-3333
  • Fax:
Mailing address:
  • Phone: 541-410-3941
  • Fax: 541-919-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2893
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500812162
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: