Individual
AYESHA MOHAMED ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
63311 JAMISON ST, BEND, OR 97703-8288
(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
084586
OR
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
L10972
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
STB-A-10184107
CERTIFIED ASSOCIATE SEX OFFENDER THERAPIST
OR
Enumeration date
05/23/2019
Last updated
05/16/2022
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