Provider Demographics
NPI:1164533352
Name:GIDNEY, LAURA KATE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KATE
Last Name:GIDNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BUTCHER RD STE A
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5695
Mailing Address - Country:US
Mailing Address - Phone:530-867-7587
Mailing Address - Fax:
Practice Address - Street 1:163 2ND ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3316
Practice Address - Country:US
Practice Address - Phone:707-365-0805
Practice Address - Fax:530-668-9194
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46964106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist