Lifesource Therapy LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

LIFESOURCE THERAPY LLC

Practice address

24455 Dodds Rd
Bend, OR 97701-9665

Phone

(541) 777-7230

NPI assigned

Apr 16, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gina R Lawrence, LPCNPI 1235545443

Title

Provider

Phone

(541) 777-7230

Specialties & licenses 1

Addresses

Other names 1

• Gina Lawrence Other name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gina Lawrence

  • Mental Health Counselor
  • Bend, OR
  • NPI 1235545443

  TX

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755475200000",
    "number": "1003660036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 NE 3RD ST STE 106",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013889",
            "telephone_number": "541-777-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24455 DODDS RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977019665",
            "telephone_number": "541-777-7230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 Lucky Dr",
            "address_purpose": "LOCATION",
            "city": "Silsbee",
            "state": "TX",
            "postal_code": "776563107",
            "country_code": "US",
            "telephone_number": "541-777-7230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFESOURCE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-16",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "541-777-7230",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gina Lawrence",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brandon W Lien, CADC-I
• Liesl Farnsworth, PHD, LPC
• Life Balance Bend LLC
• Life Dynamics LLC
• Life Works of Central Oregon, LLC
• Lifestyle Medicine of Central Oregon, PC
• Lifetime Vision Care
• Lifetime Vision Care LLC
• McKenzie L Lighty, LMT
• Matthew Raymond Lilley, MD

• Mental Health Counselor in Bend, OR
• Providers in Bend, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.