Provider Demographics
NPI:1104024249
Name:D'AMORE, LARA SIMONE
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:SIMONE
Last Name:D'AMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIMONE
Other - Middle Name:
Other - Last Name:D'AMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:7420 SW GARDEN HOME RD STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9599
Mailing Address - Country:US
Mailing Address - Phone:503-877-4608
Mailing Address - Fax:971-256-8856
Practice Address - Street 1:7420 SW GARDEN HOME RD STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-9599
Practice Address - Country:US
Practice Address - Phone:503-877-4608
Practice Address - Fax:971-256-8856
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3227101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500654105Medicaid