Healthcare Provider Details

I. General information

NPI: 1205192143
Provider Name (Legal Business Name): LA TONYA F. LAWRENCE PSYD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMBEDDED MENTAL HEALTH COMNAVSURFGRU-SW NAVAL BASE SAN DIEGO (WATERFRONT) BLDG 291
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

23623 W ATLANTA AVE
BUCKEYE AZ
85326-7382
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-8449
  • Fax:
Mailing address:
  • Phone: 480-216-7418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-005685
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-16927
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: