Individual
LAURA WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
255 LANCASTER DR NE, SALEM, OR 97301-5155
(503) 364-0775
(503) 576-8400
Mailing address
255 LANCASTER DR NE, SALEM, OR 97301-5155
(503) 364-0775
(503) 576-8400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
2469
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306275847
—
WA
01
—
R177722
MEDICARE
OR
01
—
R177723
MEDICARE
OR
Enumeration date
11/05/2013
Last updated
03/26/2021
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