Healthcare Provider Details

I. General information

NPI: 1578963476
Provider Name (Legal Business Name): LAURA MARIE SEPARA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 SE 24TH AVE
HILLSBORO OR
97123-7286
US

IV. Provider business mailing address

770 SE 24TH AVE
HILLSBORO OR
97123-7286
US

V. Phone/Fax

Practice location:
  • Phone: 503-443-9172
  • Fax:
Mailing address:
  • Phone: 503-443-9172
  • 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: