Provider Demographics
NPI:1063082964
Name:MANDEL, KRIS ANNETTE
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:ANNETTE
Last Name:MANDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 NW PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5461
Mailing Address - Country:US
Mailing Address - Phone:541-974-5488
Mailing Address - Fax:541-647-1621
Practice Address - Street 1:548 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3184
Practice Address - Country:US
Practice Address - Phone:541-388-8489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORQMHP101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor