Healthcare Provider Details

I. General information

NPI: 1982341715
Provider Name (Legal Business Name): LAURA ERIN JOACHIM MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E POWELL BLVD STE 303
GRESHAM OR
97030-7620
US

IV. Provider business mailing address

16430 SE MARNA RD
DAMASCUS OR
97089-8846
US

V. Phone/Fax

Practice location:
  • Phone: 503-308-9140
  • Fax:
Mailing address:
  • Phone: 360-224-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC10200
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: