MEDICARE: DR. LAUREL CHRISTINE EALY PSYD

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	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist	6270	NC
3	103TC0700X	Clinical Psychologist	26401	CA

General Provider Information

NPI Number	:	1902023534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREL CHRISTINE EALY PSYD

Provider Business Mailing Address
First Line	:	4149 INDIAN TRAIL RD
Second Line	:
City	:	OXFORD
State	:	NC
Zip	:	27565-7597
Country	:	US
Telephone Number	:	650-455-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 N LAKE RD
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95343-5001
Country	:	US
Telephone Number	:	650-455-3900
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/22/2025

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