Healthcare Provider Details

I. General information

NPI: 1669296257
Provider Name (Legal Business Name): LAUREN NICOLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 SALEM DALLAS HWY NW
SALEM OR
97304-3338
US

IV. Provider business mailing address

2340 RED OAK DR S
SALEM OR
97302-9418
US

V. Phone/Fax

Practice location:
  • Phone: 503-991-5091
  • Fax:
Mailing address:
  • Phone: 925-784-1362
  • 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: