Provider Demographics
NPI:1851595540
Name:BOCKING, DIANE JOYCE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:JOYCE
Last Name:BOCKING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:JOYCE
Other - Last Name:LATHROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1475 MOUNT HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9066
Mailing Address - Country:US
Mailing Address - Phone:971-983-5260
Mailing Address - Fax:971-983-5326
Practice Address - Street 1:1475 MOUNT HOOD AVE
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9066
Practice Address - Country:US
Practice Address - Phone:971-983-5260
Practice Address - Fax:971-983-5326
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2830101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500758369Medicaid