Provider Demographics
NPI:1467704775
Name:LOPACH, LAURA C (PHD,)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:LOPACH
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 NE HALSEY ST STE 335
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1568
Mailing Address - Country:US
Mailing Address - Phone:503-922-6616
Mailing Address - Fax:
Practice Address - Street 1:4224 NE HALSEY ST STE 335
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1568
Practice Address - Country:US
Practice Address - Phone:503-922-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1-16-23047103K00000X
MTPSY-PSY-2844103T00000X
OR3442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist