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General NPI Number Information
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NPI Number | 1902390875
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Entity Type | Organization
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Legal Business Name | LAURIE LA MADRID LLC DBA LAURIE LA MADRID, MFT
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 12/27/2020
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Provider Practice Location Address
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Address Line | 94-1042 KA UKA BLVD STE 203
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City | WAIPAHU
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State | HI
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Zip | 96797-6209
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Country | US
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Telephone | 808-650-2468
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Fax |
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Provider Business Mailing Address
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Address Line | 94-1042 KA UKA BLVD STE 203
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City | WAIPAHU
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State | HI
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Zip | 96797-6209
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Country | US
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Telephone | 808-650-2468
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | LAURIE L. LA MADRID
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Credential |
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Telephone | 808-650-2468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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