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General NPI Number Information
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NPI Number | 1679894323
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Entity Type | Individual
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Provider Name | LAURA BROSE MA
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Gender | Female
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 1700 MCHENRY VILLAGE WAY STE 14
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City | MODESTO
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State | CA
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Zip | 95350-4339
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Country | US
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Telephone | 209-204-6606
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 262
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City | RIVERBANK
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State | CA
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Zip | 95367-0262
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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 |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | CA
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