Provider Demographics
NPI:1083881619
Name:DEBAUN, LAURA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:DEBAUN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1877
Mailing Address - Street 2:
Mailing Address - City:LOWER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95457-1877
Mailing Address - Country:US
Mailing Address - Phone:707-994-2225
Mailing Address - Fax:
Practice Address - Street 1:9667 HIGHWAY 29
Practice Address - Street 2:SUITE 202
Practice Address - City:LOWER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95457-1877
Practice Address - Country:US
Practice Address - Phone:707-994-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist