Provider Demographics
NPI:1003325317
Name:SOUTH, LAURA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:SOUTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7366 COUNTY ROAD 180
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-7679
Mailing Address - Country:US
Mailing Address - Phone:417-793-1811
Mailing Address - Fax:
Practice Address - Street 1:7366 COUNTY ROAD 180
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-7679
Practice Address - Country:US
Practice Address - Phone:417-793-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009007303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009007303OtherLICENSED PROFESSIONAL COUNSELOR