Healthcare Provider Details

I. General information

NPI: 1952663387
Provider Name (Legal Business Name): AMY DINEEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62930 O B RILEY RD STE 200
BEND OR
97703-9459
US

IV. Provider business mailing address

399 E 10TH AVE
EUGENE OR
97401-3380
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-1919
  • Fax: 541-868-2003
Mailing address:
  • Phone: 541-330-1919
  • Fax: 541-868-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1654
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number101569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: