Individual
DIAN L ERVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2542 NE COURTNEY DR, BEND, OR 97701-7685
(541) 706-2768
(541) 706-4760
Mailing address
PO BOX 5579, BEND, OR 97708-5579
(541) 706-2768
(541) 706-4760
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2161
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500633110
—
OR
Enumeration date
08/11/2006
Last updated
06/20/2013
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