Healthcare Provider Details

I. General information

NPI: 1780597575
Provider Name (Legal Business Name): LAUREN HUMPHREYS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 NW 13TH PL
CANBY OR
97013-2851
US

IV. Provider business mailing address

265 NW 13TH PL
CANBY OR
97013-2851
US

V. Phone/Fax

Practice location:
  • Phone: 503-805-1631
  • Fax:
Mailing address:
  • Phone: 503-805-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTA.MG.70158420
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: