Provider Demographics
NPI:1629533377
Name:OMLID, ELIZABETH CHAPPELLET (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHAPPELLET
Last Name:OMLID
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:CHAPPELLET
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:20718 TOWN DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8283
Mailing Address - Country:US
Mailing Address - Phone:541-480-7740
Mailing Address - Fax:
Practice Address - Street 1:1655 SW HIGHLAND AVE STE 3
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2558
Practice Address - Country:US
Practice Address - Phone:541-923-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health