MEDICARE: MRS. LAURA BROWN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	49040	CA
2	106H00000X	Marriage & Family Therapist	47690	CA

General Provider Information

NPI Number	:	1790809366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA BROWN LMFT

Provider Business Mailing Address
First Line	:	3350 SHELBY ST
Second Line	:	SUITE 200
City	:	ONTARIO
State	:	CA
Zip	:	91764-4882
Country	:	US
Telephone Number	:	909-944-2543
Fax Number	:	909-944-2544

Provider Business Practice Location Address
First Line	:	3350 SHELBY ST
Second Line	:	SUITE 200
City	:	ONTARIO
State	:	CA
Zip	:	91764-4882
Country	:	US
Telephone Number	:	909-944-2543
Fax Number	:	909-944-2544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	03/12/2010

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