Provider Demographics
NPI:1649261595
Name:LEROY, DIANNE E (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:E
Last Name:LEROY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18173
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-0173
Mailing Address - Country:US
Mailing Address - Phone:503-299-0140
Mailing Address - Fax:503-236-2399
Practice Address - Street 1:4225 NE TILLAMOOK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1313
Practice Address - Country:US
Practice Address - Phone:503-299-9140
Practice Address - Fax:503-236-2399
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health