| Life Balance Bend Llc | |
|
15 Sw Colorado Ave Ste 350 Bend OR 97702-1130 | |
| (541) 306-1898 | |
| Not Available |
| Full Name | Life Balance Bend Llc |
|---|---|
| Speciality | Social Worker |
| Location | 15 Sw Colorado Ave Ste 350, Bend, Oregon |
| Authorized Official Name and Position | Travis Sammon (CO-OWNER) |
| Authorized Official Contact | 5413061898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Balance Bend Llc 15 Sw Colorado Ave Ste 350 Bend OR 97702-1130 Ph: (541) 306-1898 | Life Balance Bend Llc 15 Sw Colorado Ave Ste 350 Bend OR 97702-1130 Ph: (541) 306-1898 |
| NPI Number | 1669998266 |
|---|---|
| Provider Enumeration Date | 08/16/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 0244504298 |
|---|---|
| Medicare Enrollment ID | O20170914003161 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669998266 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 3873 (Oregon) | Secondary |
| 1041C0700X | Social Worker - Clinical | 4289 (Oregon) | Primary |
| Provider Name | Jillian Sammon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316218944 PECOS PAC ID: 2062659964 Enrollment ID: I20130514000270 |
| Provider Name | Travis A Sammon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033385042 PECOS PAC ID: 2163660663 Enrollment ID: I20130522000426 |
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