Provider Demographics
NPI:1457368557
Name:ENGBER, DEANNA (LPC)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:ENGBER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3519
Mailing Address - Country:US
Mailing Address - Phone:503-263-8903
Mailing Address - Fax:503-266-8632
Practice Address - Street 1:5291 NE ELAM YOUNG PKWY STE 160
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7560
Practice Address - Country:US
Practice Address - Phone:503-372-5147
Practice Address - Fax:503-640-4001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4978101YM0800X, 101YM0800X
OR218974101YP2500X
TX100468225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR50075974Medicaid
TX1457368557Medicaid
OR50075974Medicaid