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General NPI Number Information
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NPI Number | 1104700764
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Entity Type | Individual
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Provider Name | LAURA ELIZABETH WESTRA
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Gender | Female
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 1203 N MILFORD RD STE C
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City | MILFORD
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State | MI
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Zip | 48381-1033
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Country | US
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Telephone | 248-717-3616
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Fax |
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Provider Business Mailing Address
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Address Line | 29951 BRADFORD DR
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City | NEW HUDSON
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State | MI
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Zip | 48165-9201
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Country | US
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Telephone | 248-882-3596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6362010164
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License Number State | MI
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