Provider Demographics
NPI:1356512248
Name:LEBON, LAURA LOUISE (BS, CACIII)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LOUISE
Last Name:LEBON
Suffix:
Gender:F
Credentials:BS, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:CO
Mailing Address - Zip Code:80542-0283
Mailing Address - Country:US
Mailing Address - Phone:303-882-4360
Mailing Address - Fax:
Practice Address - Street 1:2130 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3177
Practice Address - Country:US
Practice Address - Phone:303-882-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6750101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6750OtherCACIII LICENSE #