Provider Demographics
NPI:1639968662
Name:DEAN, LISA ANN (QMHA/WELLNESS COACH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DEAN
Suffix:
Gender:
Credentials:QMHA/WELLNESS COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 NW QUINCY AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1527
Mailing Address - Country:US
Mailing Address - Phone:206-953-3839
Mailing Address - Fax:
Practice Address - Street 1:354 NE GREENWOOD AVE STE 202
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4632
Practice Address - Country:US
Practice Address - Phone:541-668-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
999999171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach