Provider Demographics
NPI:1376875740
Name:BACHAND, MICKI (LPC)
Entity Type:Individual
Prefix:
First Name:MICKI
Middle Name:
Last Name:BACHAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:HARBACH-BACHAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5060 SW PHILOMATH BLVD # 218
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333
Mailing Address - Country:US
Mailing Address - Phone:503-936-6163
Mailing Address - Fax:541-636-2452
Practice Address - Street 1:529 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:503-936-6163
Practice Address - Fax:541-636-2452
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06-11-03101YA0400X
101YA0400X
ORC2328101YP2500X
ORC5837101YP2500X
ORLPCC5837101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)