Provider Demographics
| NPI: | 1760224331 |
|---|---|
| Name: | LACRE, KATHARYN BRANDI (DDPSW BHPCA CHW) |
| Entity type: | Individual |
| Prefix: | |
| First Name: | KATHARYN |
| Middle Name: | BRANDI |
| Last Name: | LACRE |
| Suffix: | |
| Gender: | F |
| Credentials: | DDPSW BHPCA CHW |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 70 SW CENTURY DR STE 100-1079 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BEND |
| Mailing Address - State: | OR |
| Mailing Address - Zip Code: | 97702-3557 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 541-977-7078 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 70 SW CENTURY DR STE 100-1079 |
| Practice Address - Street 2: | |
| Practice Address - City: | BEND |
| Practice Address - State: | OR |
| Practice Address - Zip Code: | 97702-3557 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 541-977-7078 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2024-06-12 |
| Last Update Date: | 2024-08-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| OR | 101YP2500X, 172V00000X, 175F00000X | |
| 133N00000X, 171000000X, 171400000X, 171M00000X, 1744R1102X, 174N00000X, 176B00000X, 246Z00000X, 390200000X | ||
| OR | THW000110802 | 374J00000X |
| OR | NA | 2083P0901X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2083P0901X | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
| No | 171000000X | Other Service Providers | Military Health Care Provider | Group - Multi-Specialty | |
| No | 171400000X | Other Service Providers | Health & Wellness Coach | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 172V00000X | Other Service Providers | Community Health Worker | Group - Multi-Specialty | |
| No | 1744R1102X | Other Service Providers | Specialist | Research Study | Group - Multi-Specialty |
| No | 174N00000X | Other Service Providers | Lactation Consultant, Non-RN | Group - Multi-Specialty | |
| No | 175F00000X | Other Service Providers | Naturopath | Group - Multi-Specialty | |
| No | 176B00000X | Other Service Providers | Midwife | Group - Multi-Specialty | |
| No | 246Z00000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Group - Multi-Specialty | |
| No | 374J00000X | Nursing Service Related Providers | Doula | Group - Multi-Specialty | |
| No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OR | 864218 | Other | PCA-PDC (OHCC) PERSONAL CARE PROFESSIONAL CERTIFIED |
| OR | 865890 | Other | IDD-PSW OREGON STATE PLAN PERSONAL CARE SERVICES (SPPC/84-800) OHA |
| NA | Other | PCD-POSTPARTUM DOULA (SIMKIN CENTER FOR ALLIED BIRTH VOCATIONS) | |
| OR | 864218 | Other | MH-PC20 AMH-PERSONAL CARE SERVICES 20 (OREGON HEALTH AUTHORITY) |
| OR | 868421 | Other | HCW-PDC HOME CARE PROFESSIONAL CERTIFIED (OHCC) |
| OR | NA | Other | PWS-PEER WELLNESS SPECIALIST (OHA) |
| OR | THW000110802 | Other | THW-TRADITIONAL HEALTH WORKER (OHA) |
| OR | THW000110802 | Other | PSS-ADULT ADDICTIONS (OHA) |
| OR | THW000110802 | Other | YSS-YOUTH SUPPORT SPECIALIST (OHA) |
| NA | Other | CD-BIRTH DOULA (SIMKIN CENTER FOR ALLIED BIRTH VOCATIONS) | |
| OR | NA | Other | PSS-MENTAL HEALTH (OHA) |
| OR | 865890 | Other | PSW-EC (OHCC) PERSONAL SUPPORT ENHANCED CERTIFIED |
| OR | COS-FT-10184774 | Other | AESTHETICIAN (OHA-BOARD OF COSMETOLOGY) |
| OR | NA | Other | CRM-ADULT ADDICTIONS RECOVERY (MHACBO) |
| OR | THW000110802 | Other | PSS-PEER SUPPORT SPECIALIST (OHA) |
| OR | 868421 | Other | HCW-AGING AND PEOPLE WITH DISABILITIES (ODHS) |
| OR | NA | Other | FSS-FAMILY SUPPORT SPECIALIST (OHA) |
| OR | THW000110802 | Other | CHW-COMMUNITY HEALTH WORKER (OHA) |
| OR | 864218 | Other | BHPCA - OREGON MEDICAID BEHAVIORAL HEALTH PERSONAL CARE PROGRAM (OHA) |
| OR | 868421 | Other | HCW-EC HOME CARE ENHANCED CERTIFIED (OHCC) |
| OR | NA | Other | QMHA-R QUALIFIED MENTAL HEALTH ASSOCIATE (MHACBO) |
| OR | NA | Other | PSS-FAMILY SUPPORT SPECIALIST (OHA) |
| OR | THW000110802 | Other | PWS-PEER WELLNESS SPECIALIST (OHA) |
| OR | 865890 | Other | IDD-PSW CHILDREN INTENSIVE IN-HOME CARE SERVICES (SPPC/84-801) OHA |
| OR | NA | Other | PSS-YOUTH SUPPORT SPECIALIST (OHA) |
| OR | T-24-4235 | Other | CADC-R CERTIFIED ALCOHOL AND DRUG COUNSELOR (MHACBO) |
| OR | THW000110802 | Other | BIRTH DOULA (OHA) |
