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NPI Code Detail

MEDICARE: LAURA WHITE

MEDICARE: LAURA WHITE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist2469OR
2101YM0800XMental Health Counselor

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2R177723OTHERORMEDICARE
3R177722OTHERORMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306275847
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA WHITE
Provider Business Mailing Address
First Line : 255 LANCASTER DR NE
Second Line :
City : SALEM
State : OR
Zip : 97301-5155
Country : US
Telephone Number : 503-364-0775
Fax Number : 503-576-8400
Provider Business Practice Location Address
First Line : 255 LANCASTER DR NE
Second Line :
City : SALEM
State : OR
Zip : 97301-5155
Country : US
Telephone Number : 503-364-0775
Fax Number : 503-576-8400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2013
Last Update Date : 03/26/2021

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Directions to “ LAURA WHITE ” Practice Location

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