Provider Demographics
NPI:1902390875
Name:LAURIE LA MADRID LLC DBA LAURIE LA MADRID, MFT
Entity Type:Organization
Organization Name:LAURIE LA MADRID LLC DBA LAURIE LA MADRID, MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LA MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-650-2468
Mailing Address - Street 1:94-1042 KA UKA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-6209
Mailing Address - Country:US
Mailing Address - Phone:808-650-2468
Mailing Address - Fax:
Practice Address - Street 1:94-1042 KA UKA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6209
Practice Address - Country:US
Practice Address - Phone:808-650-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty