=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003741513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGH DESERT HORIZONS THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2026
-----------------------------------------------------
Last Update Date | 06/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 SE URANIA LN
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97702-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-302-3719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20789 NW HENRY AVE STE 170 #12
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-302-3719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL THERAPIST
-----------------------------------------------------
Name | SHAKARI CARSON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 828-302-3719
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------