Provider Demographics
NPI:1306516422
Name:GEFFRE, LAURA (LLPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GEFFRE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 BOARDMAN RD SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOARDMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49680-8530
Mailing Address - Country:US
Mailing Address - Phone:406-690-4508
Mailing Address - Fax:
Practice Address - Street 1:103 W 3RD ST UNIT E
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-5107
Practice Address - Country:US
Practice Address - Phone:406-690-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health