Provider Demographics
NPI:1962881706
Name:BEND THERAPIST, LLC
Entity type:Organization
Organization Name:BEND THERAPIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-410-5603
Mailing Address - Street 1:745 NW MT WASHINGTON DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1574
Mailing Address - Country:US
Mailing Address - Phone:541-410-5603
Mailing Address - Fax:
Practice Address - Street 1:2140 NW CLEARWATER DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7013
Practice Address - Country:US
Practice Address - Phone:541-410-5603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL5470251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health