MEDICARE: GLACIER LILY COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1053285270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLACIER LILY COUNSELING, LLC

Provider Business Mailing Address
First Line	:	431 NW FRANKLIN AVE STE 200
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 NW FRANKLIN AVE STE 200
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2827
Country	:	US
Telephone Number	:	541-834-9068
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	MARYAM MIRAHMADI
Credential	:	LPC
Telephone Number	:	541-834-9068

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	06/04/2026

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