Healthcare Provider Details

I. General information

NPI: 1255162657
Provider Name (Legal Business Name): COLLABORATIVE HEALING AND INTEGRATIVE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22012 SWEETGRASS DR
BEND OR
97702-9620
US

IV. Provider business mailing address

61165 S HWY 97 STE 110 #337
BEND OR
97702-4012
US

V. Phone/Fax

Practice location:
  • Phone: 541-749-0575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: SHAYLYNNE KALBERG
Title or Position: MENTAL HEALTH THERAPIST, OWNER
Credential: LCSW
Phone: 541-749-0575