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General NPI Number Information
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NPI Number | 1003579483
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Entity Type | Organization
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Legal Business Name | LAURA A BRODIE PHD CLINICAL & FORENSIC PSYCHOLOGY INC
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 1822 15TH ST
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City | GULFPORT
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State | MS
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Zip | 39501-2104
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Country | US
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Telephone | 228-678-1042
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Fax |
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Provider Business Mailing Address
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Address Line | 296 BEAUVOIR RD STE 360
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City | BILOXI
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State | MS
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Zip | 39531-4051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA BRODIE
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Credential |
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Telephone | 951-966-5652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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