Provider Demographics
NPI:1508205485
Name:DISNER, LAUREN RUTH (LMFT INTERN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:RUTH
Last Name:DISNER
Suffix:
Gender:F
Credentials:LMFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15220 NW LAIDLAW RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7716
Mailing Address - Country:US
Mailing Address - Phone:503-330-2561
Mailing Address - Fax:
Practice Address - Street 1:15220 NW LAIDLAW RD
Practice Address - Street 2:SUITE 280
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-7716
Practice Address - Country:US
Practice Address - Phone:503-330-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist