Laura Jo Park, L.M.F.T.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

T0702 Issued in OR

Practice address

2311 E. Burnside St.
Ste 102
Portland, OR 97214

Phone

(503) 388-8898

Fax

(209) 956-4245

NPI assigned

Apr 10, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Laura Jo Pomeroy Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420502400000",
    "number": "1578786505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2046",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97208",
            "telephone_number": "503-388-8898",
            "fax_number": "209-956-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 E. BURNSIDE ST.",
            "address_2": "STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97214",
            "telephone_number": "503-388-8898",
            "fax_number": "209-956-4245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "LAURA",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "L.M.F.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2015-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "IMF 39359",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T0702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "POMEROY",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jin S Park, MD
• John Joontae Park, D.D.S.
• Kaitlin Elizabeth Park
• Katherine Park
• Kristine Jayoung Park, DO
• Lindsay Meredith Park
• Lynnette Melissa Park, LPN
• Matthew Park, DMD
• Michael Park
• Nanjin Jasmine Park, DPM

• Marriage & Family Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.