Individual
SHELLEY M DICKASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
51340 HIGHWAY 97, LA PINE, OR 97739-9871
(541) 322-7500
(541) 322-7565
Mailing address
2577 NE COURTNEY DR, BEND, OR 97701-7752
(541) 322-7500
(541) 322-7565
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
19-QMHA-I-00890
OR
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/16/2018
Last updated
04/27/2023
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