Provider Demographics
NPI:1235573866
Name:GHIZ, LAURIE (LMHC, LICAC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:GHIZ
Suffix:
Gender:F
Credentials:LMHC, LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 W BOYLSTON ST STE 224
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2373
Mailing Address - Country:US
Mailing Address - Phone:508-769-0039
Mailing Address - Fax:888-350-9915
Practice Address - Street 1:354 W BOYLSTON ST STE 224
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2373
Practice Address - Country:US
Practice Address - Phone:508-769-0039
Practice Address - Fax:888-350-9915
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4067101YM0800X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health