Provider Demographics
NPI:1467326611
Name:MUSSELWHITE, LAUREN D
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:D
Last Name:MUSSELWHITE
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 1:1256 SE OLVERA PL
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9133
Mailing Address - Country:US
Mailing Address - Phone:503-573-8290
Mailing Address - Fax:
Practice Address - Street 1:1256 SE OLVERA PL
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9133
Practice Address - Country:US
Practice Address - Phone:503-804-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-QMHA-R-7663171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator