Healthcare Provider Details

I. General information

NPI: 1962856369
Provider Name (Legal Business Name): LAURA MCGRAIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N MAIN ST
HENDERSON KY
42420-3102
US

IV. Provider business mailing address

PO BOX 3612
EVANSVILLE IN
47735-3612
US

V. Phone/Fax

Practice location:
  • Phone: 812-773-8321
  • Fax:
Mailing address:
  • Phone: 812-773-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberKY 0907
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: