Healthcare Provider Details

I. General information

NPI: 1003741513
Provider Name (Legal Business Name): HIGH DESERT HORIZONS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SE URANIA LN
BEND OR
97702-1624
US

IV. Provider business mailing address

20789 NW HENRY AVE STE 170 #12
BEND OR
97703
US

V. Phone/Fax

Practice location:
  • Phone: 828-302-3719
  • Fax:
Mailing address:
  • Phone: 828-302-3719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHAKARI CARSON
Title or Position: CLINICAL THERAPIST
Credential: LCSW
Phone: 828-302-3719