Provider Demographics
NPI:1073382743
Name:MCDONOUGH, LAURA (CT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 E COUNTY LINE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440-9451
Mailing Address - Country:US
Mailing Address - Phone:330-531-7513
Mailing Address - Fax:
Practice Address - Street 1:535 MARMION AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2323
Practice Address - Country:US
Practice Address - Phone:330-782-5664
Practice Address - Fax:330-782-1614
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305275-TRNE101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional