Healthcare Provider Details

I. General information

NPI: 1013142272
Provider Name (Legal Business Name): LIZ HINCHLIFFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 04/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 NW WALL ST STE 225
BEND OR
97701-2034
US

IV. Provider business mailing address

61360 ELKHORN ST
BEND OR
97702-2189
US

V. Phone/Fax

Practice location:
  • Phone: 541-350-2578
  • Fax:
Mailing address:
  • Phone: 541-350-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberT0644
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: FARRAH ELIZABETH HINCHLIFFE
Title or Position: LICENSED MARRIAGE AND FAMILY THERAP
Credential: M.A., LMFT, LMHC
Phone: 541-350-2578