Healthcare Provider Details

I. General information

NPI: 1790786762
Provider Name (Legal Business Name): LAURIE T HADDOW LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 CENTRAL AVE
MEMPHIS TN
38111-7602
US

IV. Provider business mailing address

3950 CENTRAL AVE
MEMPHIS TN
38111-7602
US

V. Phone/Fax

Practice location:
  • Phone: 901-458-6291
  • Fax: 901-323-4848
Mailing address:
  • Phone: 901-458-6291
  • Fax: 901-323-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC0000001420
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0000001420
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0000001420
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: