Provider Demographics
NPI:1548341019
Name:CURTIS, LAURA LOUISE (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LOUISE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:2695 SR U
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-0631
Mailing Address - Country:US
Mailing Address - Phone:417-252-1942
Mailing Address - Fax:417-469-0456
Practice Address - Street 1:2695 SR U
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65793-0631
Practice Address - Country:US
Practice Address - Phone:417-252-1942
Practice Address - Fax:417-469-0456
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO497374306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO491465902Medicaid