Provider Demographics
NPI:1275153926
Name:VASEL, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VASEL
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 1:8594 E 116TH ST APT 220
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1580
Mailing Address - Country:US
Mailing Address - Phone:314-599-2034
Mailing Address - Fax:
Practice Address - Street 1:1000 VAN NUYS RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-9060
Practice Address - Country:US
Practice Address - Phone:765-593-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043348B103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist