Provider Demographics
NPI:1801520416
Name:MACOMBER, DAVID MERRILL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MERRILL
Last Name:MACOMBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19575 FISHER LAKE LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9181
Mailing Address - Country:US
Mailing Address - Phone:503-318-2335
Mailing Address - Fax:
Practice Address - Street 1:686 NW YORK DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-9857
Practice Address - Country:US
Practice Address - Phone:541-390-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional