Provider Demographics
NPI:1396010773
Name:BEND FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:BEND FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE/FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MED; LMFT
Authorized Official - Phone:541-228-4775
Mailing Address - Street 1:1045 NW BOND ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2043
Mailing Address - Country:US
Mailing Address - Phone:541-228-4775
Mailing Address - Fax:
Practice Address - Street 1:2660 NE HIGHWAY 20 STE 610
Practice Address - Street 2:#333
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6403
Practice Address - Country:US
Practice Address - Phone:541-228-4775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-18
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0722251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health