Life Balance Bend LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4289 Issued in OR

Legal business name

LIFE BALANCE BEND LLC

Practice address

15 SW Colorado Ave Ste 350
Bend, OR 97702-1130

Phone

(541) 306-1898

NPI assigned

Aug 16, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Travis Sammon, LCSWNPI 1033385042

Title

Co-Owner

Phone

(541) 306-1898

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 2

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

• Travis Sammon, MSW, LCSW

  • Clinical Social Worker
  • Bend, OR
  • NPI 1033385042
  Medicare reassignment Care Compare group NPD Authorized official
• Jillian Elizabeth Sammon, LCSW

  • Clinical Social Worker
  • Bend, OR
  • NPI 1316218944
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1669998266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SW COLORADO AVE STE 350",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021130",
            "telephone_number": "541-306-1898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SW COLORADO AVE STE 350",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021130",
            "telephone_number": "541-306-1898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "339 SW Century Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977021199",
            "country_code": "US",
            "telephone_number": "541-382-1395",
            "fax_number": "541-382-6576",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE BALANCE BEND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-16",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SAMMON",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "541-306-1898",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "3873",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "4289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Liebelt, LMT
• Leah Lieber, D.O.
• Bari Liebowitz, DC
• Brandon W Lien, CADC-I
• Liesl Farnsworth, PHD, LPC
• Life Dynamics LLC
• Life Works of Central Oregon, LLC
• Lifesource Therapy LLC
• Lifestyle Medicine of Central Oregon, PC
• Lifetime Vision Care

• Clinical Social Worker in Bend, OR
• Providers in Bend, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.