Basic Information
Provider Information | |||||||||
NPI: | 1033575311 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BINDRIM | ||||||||
FirstName: | DEVIN | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 182 SW ACADEMY ST | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | OR | ||||||||
PostalCode: | 973382150 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5036239289 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 182 SW ACADEMY ST STE 322 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | OR | ||||||||
PostalCode: | 973381900 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5038315970 | ||||||||
FaxNumber: | 5036231879 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/03/2016 | ||||||||
LastUpdateDate: | 03/16/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/16/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X |   |   | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 171M00000X |   |   | N |   | Other Service Providers | Case Manager/Care Coordinator |   | 101YM0800X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.