Healthcare Provider Details

I. General information

NPI: 1083184378
Provider Name (Legal Business Name): LAURA LYEW LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5448 NW 90TH TER
SUNRISE FL
33351-7769
US

IV. Provider business mailing address

5448 NW 90TH TER
SUNRISE FL
33351-7769
US

V. Phone/Fax

Practice location:
  • Phone: 954-655-1328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH15722
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: