Provider Demographics
NPI:1659138584
Name:HUERTA, LAURA (R8798)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HUERTA
Suffix:
Gender:F
Credentials:R8798
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 NE STUCKI AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6938
Mailing Address - Country:US
Mailing Address - Phone:971-464-6703
Mailing Address - Fax:
Practice Address - Street 1:1915 NE STUCKI AVE STE 400
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6938
Practice Address - Country:US
Practice Address - Phone:971-464-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health