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NPI Code Detail

MEDICARE: MRS. LARAMIE LANE LESINA

MEDICARE: MRS. LARAMIE LANE LESINA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1962711473
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LARAMIE LANE LESINA
Provider Business Mailing Address
First Line : 300 W MAIN ST
Second Line :
City : MEDFORD
State : OR
Zip : 97501-2756
Country : US
Telephone Number : 541-200-3356
Fax Number :
Provider Business Practice Location Address
First Line : 300 W MAIN ST
Second Line :
City : MEDFORD
State : OR
Zip : 97501-2756
Country : US
Telephone Number : 541-200-3356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2010
Last Update Date : 08/19/2019

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