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NPI Code Detail

MEDICARE: LAUREN ELIZABETH FULLER WRAY

MEDICARE: LAUREN ELIZABETH FULLER WRAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1366309718
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN ELIZABETH FULLER WRAY
Provider Business Mailing Address
First Line : 63363 SILVIS RD
Second Line :
City : BEND
State : OR
Zip : 97701-9743
Country : US
Telephone Number : 616-970-9035
Fax Number :
Provider Business Practice Location Address
First Line : 65920 OLD BEND REDMOND HWY
Second Line :
City : BEND
State : OR
Zip : 97703-7907
Country : US
Telephone Number : 505-610-0948
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2026
Last Update Date : 01/07/2026

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Directions to “ LAUREN ELIZABETH FULLER WRAY ” Practice Location

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