Provider Demographics
NPI:1679390413
Name:CORLEY, CHYANNE
Entity type:Individual
Prefix:
First Name:CHYANNE
Middle Name:
Last Name:CORLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 SE MONTEREY AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7753
Mailing Address - Country:US
Mailing Address - Phone:971-278-4594
Mailing Address - Fax:503-334-4412
Practice Address - Street 1:8305 SE MONTEREY AVE STE 111
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7753
Practice Address - Country:US
Practice Address - Phone:971-278-4594
Practice Address - Fax:503-334-4412
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health