Healthcare Provider Details

I. General information

NPI: 1083188031
Provider Name (Legal Business Name): LEE PAINTER LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2019
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 NE NORTON AVE STE 2
BEND OR
97701-4386
US

IV. Provider business mailing address

336 NE NORTON AVE STE 2
BEND OR
97701-4386
US

V. Phone/Fax

Practice location:
  • Phone: 541-948-7499
  • Fax: 888-972-8921
Mailing address:
  • Phone: 541-948-7499
  • Fax: 888-972-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ISRAEL L PAINTER
Title or Position: OWNER
Credential: LCSW
Phone: 541-948-7499