Provider Demographics
NPI:1780397554
Name:ZELL, LAURA ALICE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALICE
Last Name:ZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 SE MATHER RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8249
Mailing Address - Country:US
Mailing Address - Phone:208-310-0160
Mailing Address - Fax:
Practice Address - Street 1:10311 NE HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-5978
Practice Address - Country:US
Practice Address - Phone:360-891-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC8372101YM0800X
WAMC61229511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health