Provider Demographics
NPI:1851423776
Name:WHITEHEAD, MICHELLE (MHNP PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MHNP PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NW IRVING
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:554-138-2516
Mailing Address - Fax:541-382-6798
Practice Address - Street 1:26 NW IRVING
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:554-138-2516
Practice Address - Fax:541-382-6798
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1017103TC0700X
OR093006739N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118427Medicaid
OR0000TCKBMMedicare ID - Type Unspecified