Provider Demographics
NPI:1083181036
Name:NEALY, LAURA (BA PSY)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NEALY
Suffix:
Gender:F
Credentials:BA PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7719
Mailing Address - Country:US
Mailing Address - Phone:270-240-4892
Mailing Address - Fax:
Practice Address - Street 1:710 CARLTON DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7719
Practice Address - Country:US
Practice Address - Phone:270-240-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator