MEDICARE: DR. LAURA KORKISS GODDARD LMFT, PH.D.

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

General Provider Information

NPI Number	:	1942329073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA KORKISS GODDARD LMFT, PH.D.

Provider Business Mailing Address
First Line	:	18411 CRENSHAW BLVD STE 412
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5042
Country	:	US
Telephone Number	:	310-308-5046
Fax Number	:

Provider Business Practice Location Address
First Line	:	18411 CRENSHAW BLVD STE 412
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5042
Country	:	US
Telephone Number	:	310-308-5046
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	05/23/2023

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