Provider Demographics
NPI:1215183835
Name:BASBAS, LAUREL A, (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:A,
Last Name:BASBAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 ROOSEVELT
Mailing Address - Street 2:SUITE 240
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3670
Mailing Address - Country:US
Mailing Address - Phone:949-922-5450
Mailing Address - Fax:714-368-7500
Practice Address - Street 1:980 ROOSEVELT
Practice Address - Street 2:SUITE 240
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3670
Practice Address - Country:US
Practice Address - Phone:949-922-5450
Practice Address - Fax:714-368-7500
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10549103T00000X
CAMFT15095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist