Provider Demographics
NPI:1144938655
Name:MAYABB, LAURA (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MAYABB
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MAYABB CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:315 E BROOKVIEW LANE CT
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4201
Mailing Address - Country:US
Mailing Address - Phone:405-596-0106
Mailing Address - Fax:
Practice Address - Street 1:315 E BROOKVIEW LANE CT
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4201
Practice Address - Country:US
Practice Address - Phone:405-494-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional