Healthcare Provider Details

I. General information

NPI: 1083915490
Provider Name (Legal Business Name): LIANA WHITELEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 12/23/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SW 7TH ST
REDMOND OR
97756-2113
US

IV. Provider business mailing address

PO BOX 542
BEND OR
97709-0542
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-8459
  • Fax:
Mailing address:
  • Phone: 458-207-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number75764
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL8451
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: