Provider Demographics
NPI:1225101298
Name:LITTLE, LAURIE B (LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:B
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LIC PSYCHOLOGIST
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:B
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC PSYCHOLOGIST
Mailing Address - Street 1:4075 OLD WESTERN ROW RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-3104
Mailing Address - Country:US
Mailing Address - Phone:513-536-0232
Mailing Address - Fax:
Practice Address - Street 1:4075 OLD WESTERN ROW RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3104
Practice Address - Country:US
Practice Address - Phone:513-536-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1227103TC0700X
OHP6547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000227535OtherANTHEM BCBS ID
KY000000227535OtherANTHEM BCBS ID