Provider Demographics
NPI:1417182031
Name:OTTO, LAURA LYNN (LMHC, LPC, NCC, CCMH)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:OTTO
Suffix:
Gender:F
Credentials:LMHC, LPC, NCC, CCMH
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:DEEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, LPC, NCC, CCMH
Mailing Address - Street 1:583 SKIPPACK PIKE STE 410
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2146
Mailing Address - Country:US
Mailing Address - Phone:267-405-6803
Mailing Address - Fax:267-604-9091
Practice Address - Street 1:583 SKIPPACK PIKE STE 410
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2146
Practice Address - Country:US
Practice Address - Phone:267-405-6803
Practice Address - Fax:267-604-9091
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004912101YP2500X, 101YP2500X
PAPC006387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional