Healthcare Provider Details

I. General information

NPI: 1205474137
Provider Name (Legal Business Name): LAURIE C REIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 LACLAIR ST
COOS BAY OR
97420-2988
US

IV. Provider business mailing address

PO BOX 712
COOS BAY OR
97420-0135
US

V. Phone/Fax

Practice location:
  • Phone: 541-266-6769
  • Fax:
Mailing address:
  • Phone: 707-537-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL16012
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: