Provider Demographics
NPI:1376932350
Name:LUY, KASEY CHANNARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KASEY
Middle Name:CHANNARA
Last Name:LUY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:K.C.
Other - Middle Name:NARA
Other - Last Name:LUY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2315 TANNLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4164
Mailing Address - Country:US
Mailing Address - Phone:503-866-9809
Mailing Address - Fax:
Practice Address - Street 1:10260 SW GREENBURG RD STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5514
Practice Address - Country:US
Practice Address - Phone:503-293-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2567103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist