Individual
ELIZABETH ANN BERNARDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CM II
Contact information
Practice address
1115 HAR-BER RD, GROVE, OK 74344
(844) 458-2100
(918) 796-4435
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
22-QMHA-R-2935
OR
175T00000X
Peer Specialist
22-CRM-114
OR
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2733121
ODL
OR
05
—
500808956
—
OR
01
—
THW107282
PEER SUPPORT -ADULT ADDICTIONS
OR
Enumeration date
07/18/2022
Last updated
11/13/2023
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