Provider Demographics
NPI:1447922794
Name:BINGHAM, LAUREN A (MA, LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 NE BAKER ST STE 260
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4950
Mailing Address - Country:US
Mailing Address - Phone:971-213-5025
Mailing Address - Fax:971-228-5431
Practice Address - Street 1:609 NE BAKER ST STE 260
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4950
Practice Address - Country:US
Practice Address - Phone:971-213-5025
Practice Address - Fax:971-228-5431
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC8889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500799415Medicaid