Provider Demographics
NPI:1730614702
Name:KREISELMAIER, LAURA ROSSER (PHD, LCPT)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ROSSER
Last Name:KREISELMAIER
Suffix:
Gender:F
Credentials:PHD, LCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 E ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5024
Mailing Address - Country:US
Mailing Address - Phone:615-651-9815
Mailing Address - Fax:
Practice Address - Street 1:762 E ARGYLE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5024
Practice Address - Country:US
Practice Address - Phone:615-651-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN60101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health