Provider Demographics
NPI:1790281228
Name:ESPINOZA, LORILYNN (MS, LPC INTERN)
Entity Type:Individual
Prefix:MS
First Name:LORILYNN
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:MS, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 REED RD SE STE 150
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1335
Mailing Address - Country:US
Mailing Address - Phone:503-581-1732
Mailing Address - Fax:503-363-4607
Practice Address - Street 1:4080 REED RD SE STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1335
Practice Address - Country:US
Practice Address - Phone:541-557-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6308101YP2500X
ORR5184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1790281228Medicaid