Healthcare Provider Details

I. General information

NPI: 1598047045
Provider Name (Legal Business Name): DIANNA HARRIS PSYD, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2011
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NW HARRIMAN ST STE E
BEND OR
97703-1912
US

IV. Provider business mailing address

1900 NE 3RD ST SUITE 106 PMB 3006
BEND OR
97701-3889
US

V. Phone/Fax

Practice location:
  • Phone: 541-516-6357
  • Fax: 877-816-0645
Mailing address:
  • Phone: 541-516-6357
  • Fax: 877-816-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2224
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202210894NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: