Provider Demographics
NPI:1851851430
Name:CASCADIA FAMILY THERAPY
Entity Type:Organization
Organization Name:CASCADIA FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:541-639-2986
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1028
Mailing Address - Country:US
Mailing Address - Phone:541-639-2986
Mailing Address - Fax:
Practice Address - Street 1:780 NW YORK DR STE 204
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1055
Practice Address - Country:US
Practice Address - Phone:541-639-2986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty