Provider Demographics
NPI:1285013961
Name:VAN LAER, AASHER (QMHA)
Entity Type:Individual
Prefix:
First Name:AASHER
Middle Name:
Last Name:VAN LAER
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:AASHER
Other - Middle Name:
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32046 SCAPPOOSE VERNONIA HWY
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-2318
Mailing Address - Country:US
Mailing Address - Phone:971-271-1841
Mailing Address - Fax:503-294-4321
Practice Address - Street 1:12121 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3737
Practice Address - Country:US
Practice Address - Phone:971-361-7700
Practice Address - Fax:503-954-1095
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500694101Medicaid