Healthcare Provider Details

I. General information

NPI: 1639010184
Provider Name (Legal Business Name): ENLIGHTENED PATHWAYS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 NE KRISTI CT STE 106
BEND OR
97701-6666
US

IV. Provider business mailing address

1900 NE 3RD ST STE 106
BEND OR
97701-3889
US

V. Phone/Fax

Practice location:
  • Phone: 765-461-6829
  • 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

VIII. Authorized Official

Name: BREANA STANFORD
Title or Position: LCSW
Credential: STANFORD
Phone: 765-461-6829