Healthcare Provider Details

I. General information

NPI: 1235545443
Provider Name (Legal Business Name): GINA LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24455 DODDS RD
BEND OR
97701-9665
US

IV. Provider business mailing address

1900 NE 3RD ST STE 106 PBM 3041
BEND OR
97701-3889
US

V. Phone/Fax

Practice location:
  • Phone: 541-777-7230
  • Fax: 541-923-7139
Mailing address:
  • Phone: 541-777-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC4474
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6785
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: