Doctor Name: | KELLY SHIELDS-DIDEHBANI |
NPI Number: | 1083075790 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | C3406 |
Business Practice Address: | 5228 Ne Hoyt St Portland, OR - 972133055 |
Business Phone Number: | 5032156474 |
Business Fax Number: | |
Mailing Address: | Po Box 3395, PORTLAND |
State: | OR |
Postal Code: | 972083395 |
Phone Number: | 5032156474 |
Fax Number: | |
NPI Enumeration Date: | 03/09/2016 |
NPI Last Update Date: | 03/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | C3406 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |