Provider Demographics
NPI:1093322299
Name:LAUGHTON, JESSICA (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LAUGHTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 BARKELEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1848 BARKELEY AVE
Practice Address - Street 2:BLDG 1657
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-0001
Practice Address - Country:US
Practice Address - Phone:719-526-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0810007974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program