Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | R4207 | OR |
N | 101YP1600X | Pastoral Counselor | R4207 | OR |
Y | 101YP2500X | Professional Counselor | R4207 | OR |
NPI | 1346794591 |
---|---|
Provider Name | Kimberly Drew |
First Address | Bend, OR 97703-2776 |
Second Address | Bend, OR 97703-2776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2016 |
Last Update Date | 04/08/2016 |