Healthcare Provider Details

I. General information

NPI: 1629651997
Provider Name (Legal Business Name): LAUREN HISADA LPC, HTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 WILLAMETTE FALLS DR
WEST LINN OR
97068-4652
US

IV. Provider business mailing address

1880 WILLAMETTE FALLS DR STE 220
WEST LINN OR
97068-4655
US

V. Phone/Fax

Practice location:
  • Phone: 503-765-7744
  • Fax: 844-927-4454
Mailing address:
  • Phone: 503-765-7744
  • Fax: 844-927-4454

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: