Provider Demographics
NPI:1801284500
Name:WITHERSPOON, MALLORY (MS)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 NE CARSON WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6243
Mailing Address - Country:US
Mailing Address - Phone:541-326-2208
Mailing Address - Fax:
Practice Address - Street 1:515 SW CASCADE AVE STE 6
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2298
Practice Address - Country:US
Practice Address - Phone:458-666-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-03
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst