Healthcare Provider Details

I. General information

NPI: 1366309718
Provider Name (Legal Business Name): LAUREN ELIZABETH FULLER WRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65920 OLD BEND REDMOND HWY
BEND OR
97703-7907
US

IV. Provider business mailing address

63363 SILVIS RD
BEND OR
97701-9743
US

V. Phone/Fax

Practice location:
  • Phone: 505-610-0948
  • Fax:
Mailing address:
  • Phone: 616-970-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: