Provider Demographics
NPI:1811590854
Name:OXLEY, DIANA K (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:OXLEY
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 SW MULTNOMAH BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4070
Mailing Address - Country:US
Mailing Address - Phone:503-592-3429
Mailing Address - Fax:
Practice Address - Street 1:2929 SW MULTNOMAH BLVD STE 107
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4070
Practice Address - Country:US
Practice Address - Phone:503-592-3429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5840101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional