Provider Demographics
NPI:1760763635
Name:DOEHASS-IMEL, LAURIE JO (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:JO
Last Name:DOEHASS-IMEL
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:J
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:NEOTSU
Mailing Address - State:OR
Mailing Address - Zip Code:97364-0821
Mailing Address - Country:US
Mailing Address - Phone:541-921-1504
Mailing Address - Fax:620-682-9840
Practice Address - Street 1:9252 S. SCHOONER CREEK RD
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:OR
Practice Address - Zip Code:97368-9252
Practice Address - Country:US
Practice Address - Phone:541-921-1504
Practice Address - Fax:620-272-9833
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43851041C0700X
ORL128881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical