Basic Information
| Provider Information | |||||||||
| NPI: | 1396891156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEINRICH | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | GRIFFIN | ||||||||
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| Credential: | M.F.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 N. MOUNTAIN STREET | ||||||||
| Address2: | ROSS BUILDING 3-H | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89703 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 MOUNTAIN ST | ||||||||
| Address2: | ROSS BUILDING 3-H | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897033822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457756 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 01021 | NV | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.