Healthcare Provider Details

I. General information

NPI: 1619774759
Provider Name (Legal Business Name): EBB AND FLOW MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 03/28/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 SW SCALEHOUSE LOOP STE 204
BEND OR
97702-1277
US

IV. Provider business mailing address

231 SW SCALEHOUSE LOOP STE 204
BEND OR
97702-1277
US

V. Phone/Fax

Practice location:
  • Phone: 541-648-7980
  • Fax: 541-391-5500
Mailing address:
  • Phone: 541-648-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY AURORA SAPIN
Title or Position: PMHNP-BC, FNP-BC
Credential: APRN-BC
Phone: 541-648-7980