Provider Demographics
NPI:1093939027
Name:DUTART, LAURIE ANNE (MFT)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANNE
Last Name:DUTART
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 SAN MARINO DRIVE.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4600
Mailing Address - Country:US
Mailing Address - Phone:760-215-5054
Mailing Address - Fax:
Practice Address - Street 1:1132 SAN MARINO DRIVE.
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4600
Practice Address - Country:US
Practice Address - Phone:760-215-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist