Healthcare Provider Details

I. General information

NPI: 1609909472
Provider Name (Legal Business Name): LAURIE JEAN EATON MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 ROSEMEAD BLVD 2ND FLOOR
EL MONTE CA
91731
US

IV. Provider business mailing address

6221 GREGORY AVE
WHITTIER CA
90601
US

V. Phone/Fax

Practice location:
  • Phone: 626-227-7014
  • Fax: 626-227-7015
Mailing address:
  • Phone: 562-695-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC34240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: