Basic Information
| Provider Information | |||||||||
| NPI: | 1609909472 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EATON | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6221 GREGORY AVE | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626951779 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3208 ROSEMEAD BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262277014 | ||||||||
| FaxNumber: | 6262277015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | MFC34240 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | ENK1233 | 01 | CA | LOS ANGELES DEPT OF MENTA | OTHER |