Provider Demographics
NPI:1013599539
Name:LAURA DESANTIS LPCC THERAPY SERVICES INC
Entity Type:Organization
Organization Name:LAURA DESANTIS LPCC THERAPY SERVICES INC
Other - Org Name:LAURA DESANTIS LPCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPCC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPHILED
Authorized Official - Phone:415-376-7385
Mailing Address - Street 1:655 MONTGOMERY STREET, STE 490
Mailing Address - Street 2:DPT#17076
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111
Mailing Address - Country:US
Mailing Address - Phone:415-935-0947
Mailing Address - Fax:
Practice Address - Street 1:655 MONTGOMERY STREET, STE 490
Practice Address - Street 2:DPT#17076
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111
Practice Address - Country:US
Practice Address - Phone:415-376-7385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health