Basic Information
| Provider Information | |||||||||
| NPI: | 1073953345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMENTS | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | RN-PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7650 SW BEVELAND RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036013615 | ||||||||
| FaxNumber: | 5036461683 | ||||||||
| Practice Location | |||||||||
| Address1: | 19250 SW 65TH AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970627707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036921242 | ||||||||
| FaxNumber: | 5036913615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 201340303RN | OR | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 201501816NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 500683936 | 05 | OR | MEDICAID | 500683937 | 05 | OR | MEDICAID |