Healthcare Provider Details

I. General information

NPI: 1033532619
Provider Name (Legal Business Name): LAURA LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2014
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 N DECATUR BLVD STE D
LAS VEGAS NV
89108-2957
US

IV. Provider business mailing address

2481 N DECATUR BLVD STE D
LAS VEGAS NV
89108-2957
US

V. Phone/Fax

Practice location:
  • Phone: 702-527-6337
  • Fax: 702-979-9688
Mailing address:
  • Phone: 702-527-6337
  • Fax: 702-979-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5665-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: