Provider Demographics
NPI:1033139860
Name:WINDLE, LAURIE L (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:L
Last Name:WINDLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 WILSHIRE BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3101
Mailing Address - Country:US
Mailing Address - Phone:213-427-3220
Mailing Address - Fax:213-427-3288
Practice Address - Street 1:3807 WILSHIRE BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3101
Practice Address - Country:US
Practice Address - Phone:213-427-3220
Practice Address - Fax:213-427-3288
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16577101YM0800X, 103TB0200X, 103TC0700X, 103TC1900X, 103TF0000X, 103TH0100X, 103TP2701X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy