Provider Demographics
NPI:1275250086
Name:HANLEY, CYNTHIA DIANE (QMHP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANE
Last Name:HANLEY
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:DIANE
Other - Last Name:PFAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51600 HUNTINGTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-8887
Mailing Address - Country:US
Mailing Address - Phone:541-536-3435
Mailing Address - Fax:541-536-8047
Practice Address - Street 1:51600 HUNTINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-8887
Practice Address - Country:US
Practice Address - Phone:541-536-3435
Practice Address - Fax:541-536-8047
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA156631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical