Healthcare Provider Details

I. General information

NPI: 1376043653
Provider Name (Legal Business Name): ANN THOMAS LAING LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20241 W VALLEY BLVD STE D
TEHACHAPI CA
93561-8746
US

IV. Provider business mailing address

21004 RIDGEWAY DR
TEHACHAPI CA
93561-6943
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-8979
  • Fax:
Mailing address:
  • Phone: 661-808-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT30877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: