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General NPI Number Information
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NPI Number | 1811484603
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Entity Type | Organization
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Legal Business Name | PATH TO AWARENESS PC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 2239 NE DOCTORS DR STE 110
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City | BEND
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State | OR
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Zip | 97701-7185
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Country | US
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Telephone | 541-323-8705
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Fax | 541-323-8708
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Provider Business Mailing Address
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Address Line | 2239 NE DOCTORS DR STE 110
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City | BEND
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State | OR
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Zip | 97701-7185
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Country | US
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Telephone | 541-323-8705
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Fax | 541-323-8707
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | FAITH BROWN
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Credential |
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Telephone | 541-323-8705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD28568
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License Number State | OR
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