Provider Demographics
NPI:1316598642
Name:CRANE, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CRANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4524
Mailing Address - Country:US
Mailing Address - Phone:509-713-9348
Mailing Address - Fax:
Practice Address - Street 1:8600 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4524
Practice Address - Country:US
Practice Address - Phone:509-713-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2024-04-19
Deactivation Date:2024-03-27
Deactivation Code:
Reactivation Date:2024-04-19
Provider Licenses
StateLicense IDTaxonomies
ORR7388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health