Provider Demographics
NPI:1295836559
Name:PHILLIPS, LAURA MARIE (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CHESTNUT ST E
Mailing Address - Street 2:SUITE 400
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5116
Mailing Address - Country:US
Mailing Address - Phone:651-344-6204
Mailing Address - Fax:651-344-4949
Practice Address - Street 1:116 CHESTNUT ST E
Practice Address - Street 2:SUITE 400
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5116
Practice Address - Country:US
Practice Address - Phone:651-344-6204
Practice Address - Fax:651-344-4949
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1496106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1295836559Medicaid