Provider Demographics
NPI:1598811861
Name:DEBORAH L. MACWILLIAMS, PHD PMHNP P.C.
Entity Type:Organization
Organization Name:DEBORAH L. MACWILLIAMS, PHD PMHNP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MACWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PMHNP
Authorized Official - Phone:541-617-0351
Mailing Address - Street 1:780 NW YORK DR STE 208
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1053
Mailing Address - Country:US
Mailing Address - Phone:541-617-0351
Mailing Address - Fax:541-383-9260
Practice Address - Street 1:780 NW YORK DR STE 208
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1053
Practice Address - Country:US
Practice Address - Phone:541-617-0351
Practice Address - Fax:541-383-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350134NP-PMHNP-PP174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty