MEDICARE: MRS. LAURA B WINGARD MA, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	93578	CA

General Provider Information

NPI Number	:	1679177414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA B WINGARD MA, MS

Provider Business Mailing Address
First Line	:	1801 N CATALINA ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1208
Country	:	US
Telephone Number	:	949-922-9276
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4316
Country	:	US
Telephone Number	:	657-888-3494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	09/10/2025

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