=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073409942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA LEE GAYMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2025
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | DHHS COUNTY OF DEL NORTE (BHD) 455 K ST
-----------------------------------------------------
City | CRESCENT CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-464-7224
-----------------------------------------------------
Fax | 707-465-4272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BEHAVIORAL HEALTH SPECIALIST 910 EASY STREET
-----------------------------------------------------
City | BROOKINGS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-510-6455
-----------------------------------------------------
Fax | 707-465-4272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number | 1073409942
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------