Healthcare Provider Details

I. General information

NPI: 1255809158
Provider Name (Legal Business Name): MICHELLE HALLINAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 SW SHEVLIN HIXON DR STE 201
BEND OR
97702-1137
US

IV. Provider business mailing address

320 SW CENTURY DR STE 405-175
BEND OR
97702-3037
US

V. Phone/Fax

Practice location:
  • Phone: 541-581-0085
  • Fax: 541-610-1884
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW26639
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7876
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: