Healthcare Provider Details

I. General information

NPI: 1801675269
Provider Name (Legal Business Name): LAURA ANNE KHAN LPC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 N SHORE DR BLDG 1B
PITTSBURGH PA
15212-5875
US

IV. Provider business mailing address

125 NEVILLE DR
MARLTON NJ
08053-4509
US

V. Phone/Fax

Practice location:
  • Phone: 646-453-6777
  • Fax:
Mailing address:
  • Phone: 973-787-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number17-031
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010057
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: