Provider Demographics
NPI:1598047045
Name:HARRIS, DIANNA (PSYD, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSYD, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NE 3RD ST
Mailing Address - Street 2:SUITE 106 PMB 3006
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3889
Mailing Address - Country:US
Mailing Address - Phone:541-516-6357
Mailing Address - Fax:877-816-0645
Practice Address - Street 1:1010 NW HARRIMAN ST STE E
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1912
Practice Address - Country:US
Practice Address - Phone:541-516-6357
Practice Address - Fax:877-816-0645
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2224103TC0700X
OR202210894NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WDBCHOtherMEDICARE GROUP
OR164936Medicaid