Provider Demographics
NPI:1225474216
Name:WILLMOTT, LAURA ANN
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:WILLMOTT
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 1:9140 W LA MADRE WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3509
Mailing Address - Country:US
Mailing Address - Phone:702-219-1728
Mailing Address - Fax:
Practice Address - Street 1:9140 W LA MADRE WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3509
Practice Address - Country:US
Practice Address - Phone:702-219-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor