Provider Demographics
NPI:1407446743
Name:BEND MENTAL WELLNESS LLC
Entity Type:Organization
Organization Name:BEND MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-357-7686
Mailing Address - Street 1:64682 COOK AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-9033
Mailing Address - Country:US
Mailing Address - Phone:541-357-7686
Mailing Address - Fax:
Practice Address - Street 1:19855 4TH ST STE 106
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7814
Practice Address - Country:US
Practice Address - Phone:541-357-7686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty