Provider Demographics
NPI:1285821686
Name:WIIG, LAUREL (PHD LMFT)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:WIIG
Suffix:
Gender:F
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11145 TAMPA AVE STE 27A
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2274
Mailing Address - Country:US
Mailing Address - Phone:310-774-1364
Mailing Address - Fax:
Practice Address - Street 1:11145 TAMPA AVE STE 27A
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2274
Practice Address - Country:US
Practice Address - Phone:310-774-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42813101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional