Basic Information
| Provider Information | |||||||||
| NPI: | 1366716805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29052 SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | VAL VERDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913842443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612950912 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6400 LAUREL CANYON BLVD STE 500 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916061562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189016376 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2012 | ||||||||
| LastUpdateDate: | 03/04/2019 | ||||||||
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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 | 106H00000X | AMFT78525 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.