Provider Demographics
NPI:1134319742
Name:LAWRENCE, NICOLE (MA MFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 S DOHENY DR
Mailing Address - Street 2:SUITE 1421
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3508
Mailing Address - Country:US
Mailing Address - Phone:310-203-1399
Mailing Address - Fax:
Practice Address - Street 1:9107 WILSHIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5508
Practice Address - Country:US
Practice Address - Phone:310-203-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44747101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health