Provider Demographics
NPI:1942803713
Name:CASCADE PSYCHOLOGICAL SERVICES, LCC
Entity Type:Organization
Organization Name:CASCADE PSYCHOLOGICAL SERVICES, LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SHAWVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:541-508-7746
Mailing Address - Street 1:19800 VILLAGE OFFICE CT STE 205
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1813
Mailing Address - Country:US
Mailing Address - Phone:541-508-7746
Mailing Address - Fax:
Practice Address - Street 1:19800 VILLAGE OFFICE CT STE 205
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1813
Practice Address - Country:US
Practice Address - Phone:541-508-7746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty