Provider Demographics
NPI:1770022493
Name:LAURA MARIE SEPARA THERAPY SERVICES
Entity Type:Organization
Organization Name:LAURA MARIE SEPARA THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA, LPC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SEPARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-724-0943
Mailing Address - Street 1:199 NE IRONCREEK TER
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 SW ALDER ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3625
Practice Address - Country:US
Practice Address - Phone:503-724-0943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4399251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health