Healthcare Provider Details

I. General information

NPI: 1114864733
Provider Name (Legal Business Name): LAURA SUMPTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N 1ST AVE FL 2
STAYTON OR
97383-1701
US

IV. Provider business mailing address

PO BOX 134
STAYTON OR
97383-0134
US

V. Phone/Fax

Practice location:
  • Phone: 503-507-9286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR8994
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: