Provider Demographics
NPI:1255809158
Name:HALLINAN, MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:HALLINAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SW CENTURY DR STE 405-175
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:147 SW SHEVLIN HIXON DR STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1137
Practice Address - Country:US
Practice Address - Phone:541-581-0085
Practice Address - Fax:541-610-1884
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW266391041C0700X
ORL78761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical