Bend Mental Wellness LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

BEND MENTAL WELLNESS LLC

Practice address

19855 4TH St Ste 106
Bend, OR 97703-7814

Phone

(541) 357-7686

NPI assigned

Jan 20, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edgar Julian Caballero, LPCNPI 1376915686

Title

Owner

Phone

(541) 357-7686

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edgar Julian Caballero, LPC

  • Counselor
  • Bend, OR
  • NPI 1376915686
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683590400000",
    "number": "1407446743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64682 COOK AVE # 1",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977039033",
            "telephone_number": "541-357-7686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19855 4TH ST STE 106",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037814",
            "telephone_number": "541-357-7686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1345 NW Wall St Ste 303",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977031970",
            "country_code": "US",
            "telephone_number": "541-357-7686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEND MENTAL WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-20",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A",
        "authorized_official_last_name": "CABALLERO",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_middle_name": "JULIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-357-7686",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Bend, OR
• Providers in Bend, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.