Basic Information
| Provider Information | |||||||||
| NPI: | 1033463922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IBARRA | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 COTTS WAY | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483714874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488424520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 269 SUMMIT DR | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483283364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486811940 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2012 | ||||||||
| LastUpdateDate: | 10/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401012647 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.