Provider Demographics
NPI:1376819342
Name:BERRY, LAURA L (NCC, ILLINOIS LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:BERRY
Suffix:
Gender:F
Credentials:NCC, ILLINOIS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10304 DANICHRIS WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-1631
Mailing Address - Country:US
Mailing Address - Phone:708-232-0259
Mailing Address - Fax:
Practice Address - Street 1:900 FULTON AVE # 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4500
Practice Address - Country:US
Practice Address - Phone:916-484-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2017-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor