Provider Demographics
NPI:1891066346
Name:DECAMBRA, XAN K
Entity Type:Individual
Prefix:
First Name:XAN
Middle Name:K
Last Name:DECAMBRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:XAN
Other - Middle Name:
Other - Last Name:TAM HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:965 LIBERTY ST SE
Mailing Address - Street 2:965 POYAMA COUNSELING SERVICES
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-8804
Mailing Address - Country:US
Mailing Address - Phone:503-588-2004
Mailing Address - Fax:503-588-2415
Practice Address - Street 1:965 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4138
Practice Address - Country:US
Practice Address - Phone:503-588-2004
Practice Address - Fax:503-588-2415
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist