Healthcare Provider Details

I. General information

NPI: 1851249924
Provider Name (Legal Business Name): CAMRYN RAE LICURSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 SW DORION AVE
PENDLETON OR
97801-2037
US

IV. Provider business mailing address

78664 S HIGHWAY 207
HERMISTON OR
97838-8446
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-0550
  • Fax:
Mailing address:
  • Phone: 541-429-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11495
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: