Provider Demographics
NPI:1093114431
Name:OWENS, LAURA VICTORIA (LMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:VICTORIA
Last Name:OWENS
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 1:8108 S GOLD BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-3480
Mailing Address - Country:US
Mailing Address - Phone:208-371-1806
Mailing Address - Fax:
Practice Address - Street 1:1655 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5100
Practice Address - Country:US
Practice Address - Phone:208-371-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5659101YP2500X
ID6208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional