Healthcare Provider Details

I. General information

NPI: 1255276465
Provider Name (Legal Business Name): STACEY L COME CDAC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 SW HIGHLAND AVE STE 5
REDMOND OR
97756-2558
US

IV. Provider business mailing address

61395 WHITE TAIL ST
BEND OR
97702-2779
US

V. Phone/Fax

Practice location:
  • Phone: 541-925-2654
  • Fax:
Mailing address:
  • Phone: 541-306-0286
  • Fax: 541-306-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number95386
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: