Provider Demographics
NPI:1598133415
Name:DAHLA, AMY (LPC, LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DAHLA
Suffix:
Gender:F
Credentials:LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 SISKIYOU BLVD # 518
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2336
Mailing Address - Country:US
Mailing Address - Phone:541-363-7309
Mailing Address - Fax:
Practice Address - Street 1:140 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3113
Practice Address - Country:US
Practice Address - Phone:541-774-8201
Practice Address - Fax:541-774-7979
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15947101YP2500X
ORC4743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional