Healthcare Provider Details

I. General information

NPI: 1588992044
Provider Name (Legal Business Name): LAURA LEIGH BAGE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 03/10/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HIGHWAY 95A BLDG G701
FERNLEY NV
89408
US

IV. Provider business mailing address

415 HIGHWAY 95 BLDG G701
FERNLEY NV
89408-6583
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-2144
  • Fax: 775-575-2100
Mailing address:
  • Phone: 775-575-2144
  • Fax: 775-575-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number01343
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number01343
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: