Healthcare Provider Details

I. General information

NPI: 1497143945
Provider Name (Legal Business Name): LAURA NUNEZ MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 10/30/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 1 STREET
COLONA IL
61241
US

IV. Provider business mailing address

4709 44TH ST STE 5
ROCK ISLAND IL
61201-7187
US

V. Phone/Fax

Practice location:
  • Phone: 309-431-1555
  • Fax: 855-515-0810
Mailing address:
  • Phone: 309-793-3460
  • Fax: 309-732-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000991
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: