Provider Demographics
NPI:1356482780
Name:MANSOOR, LAUREL GAIL (LCSW, CADC1)
Entity Type:Individual
Prefix:MISS
First Name:LAUREL
Middle Name:GAIL
Last Name:MANSOOR
Suffix:
Gender:F
Credentials:LCSW, CADC1
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:G
Other - Last Name:MANSOOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, CADC1
Mailing Address - Street 1:621 SW ALDER ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3620
Mailing Address - Country:US
Mailing Address - Phone:503-494-4745
Mailing Address - Fax:503-494-4747
Practice Address - Street 1:621 SW ALDER ST STE 520
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3620
Practice Address - Country:US
Practice Address - Phone:503-494-4745
Practice Address - Fax:503-494-4747
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL45021041C0700X
OR10-09-34101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)