Provider Demographics
NPI:1164667994
Name:MOCK, LAURA ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:MOCK
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 1:31995 GEORGE SMITH RD
Mailing Address - Street 2:
Mailing Address - City:SQUAW VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93675-9639
Mailing Address - Country:US
Mailing Address - Phone:559-802-6113
Mailing Address - Fax:
Practice Address - Street 1:7080 N MARKS AVE
Practice Address - Street 2:104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0288
Practice Address - Country:US
Practice Address - Phone:559-248-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor