Healthcare Provider Details

I. General information

NPI: 1538475868
Provider Name (Legal Business Name): CASCADE BEHAVIORAL COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NW PARK PL
BEND OR
97701-2954
US

IV. Provider business mailing address

25 NW PARK PL
BEND OR
97701-2954
US

V. Phone/Fax

Practice location:
  • Phone: 541-647-4931
  • Fax: 541-318-4600
Mailing address:
  • Phone: 541-647-4931
  • Fax: 541-318-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3731
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MEGHAN FLAHERTY
Title or Position: DIRECTOR
Credential: LCSW
Phone: 541-647-4931