Healthcare Provider Details

I. General information

NPI: 1689078529
Provider Name (Legal Business Name): LAURIE HUFFMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10564 SE WASHINGTON STRRET
PORTLAND OR
97216
US

IV. Provider business mailing address

3910 SE STARK ST
PORTLAND OR
97214-3241
US

V. Phone/Fax

Practice location:
  • Phone: 503-235-8655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC1587
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1587
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: