Provider Demographics
NPI:1548932601
Name:PICARD, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PICARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 W OLYMPIC BLVD # 114
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2670
Mailing Address - Country:US
Mailing Address - Phone:323-510-7571
Mailing Address - Fax:
Practice Address - Street 1:3171 W OLYMPIC BLVD # 114
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2670
Practice Address - Country:US
Practice Address - Phone:323-510-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health