Provider Demographics
NPI:1174833024
Name:CHANTARABUNCHORN, NAIYANA (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:NAIYANA
Middle Name:
Last Name:CHANTARABUNCHORN
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 NE STUCKI AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6938
Mailing Address - Country:US
Mailing Address - Phone:971-238-4990
Mailing Address - Fax:
Practice Address - Street 1:1915 NE STUCKI AVE STE 400
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6938
Practice Address - Country:US
Practice Address - Phone:971-238-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8549101YM0800X
ORC2684101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty