Individual
AVERY GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHP
Contact information
Practice address
1058 NE 12TH ST, BEND, OR 97701-4412
(541) 678-5320
Mailing address
1058 NE 12TH ST, BEND, OR 97701-4412
(541) 678-5320
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
22-QMHP-R-1292
OR
171100000X
Acupuncturist
17331
CA
Other
Enumeration date
12/01/2016
Last updated
06/28/2022
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