Provider Demographics
NPI:1275968166
Name:TARTER, LAURIE KRISTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:KRISTINE
Last Name:TARTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 FARADAY AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7238
Mailing Address - Country:US
Mailing Address - Phone:858-822-8277
Mailing Address - Fax:888-907-7476
Practice Address - Street 1:2292 FARADAY AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7238
Practice Address - Country:US
Practice Address - Phone:858-822-8277
Practice Address - Fax:888-907-7476
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X, 103K00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health