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General NPI Number Information
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NPI Number | 1912367160
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Entity Type | Organization
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Legal Business Name | LAUREL COUNSELING & CONSULTATION SERVICES
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 138 CIVIC CENTER DR STE 116
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City | VISTA
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State | CA
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Zip | 92084-6041
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Country | US
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Telephone | 619-944-8293
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Fax |
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Provider Business Mailing Address
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Address Line | 138 CIVIC CENTER DR STE 116
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City | VISTA
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State | CA
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Zip | 92084-6041
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Country | US
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Telephone | 619-944-8293
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEWIS JEFFERY LEE
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Credential | LMFT, DMIN, BCC
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Telephone | 619-944-8293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LMFT86487
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License Number State | CA
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