Healthcare Provider Details

I. General information

NPI: 1306516422
Provider Name (Legal Business Name): LAURA GEFFRE LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W 3RD ST UNIT E
KALKASKA MI
49646-5107
US

IV. Provider business mailing address

2980 BOARDMAN RD SW
SOUTH BOARDMAN MI
49680-8530
US

V. Phone/Fax

Practice location:
  • Phone: 406-690-4508
  • Fax:
Mailing address:
  • Phone: 406-690-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451019856
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: