Healthcare Provider Details

I. General information

NPI: 1669306080
Provider Name (Legal Business Name): ELLA NICOLE CLOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 SW HIGHLAND AVE STE 3
REDMOND OR
97756-2558
US

IV. Provider business mailing address

19330 INNES MARKET RD
BEND OR
97703-8124
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-2654
  • Fax:
Mailing address:
  • Phone: 818-321-0883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: