Provider Demographics
NPI:1417339342
Name:SOTO, LAURA S (MC; MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:SOTO
Suffix:
Gender:F
Credentials:MC; MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 N PANTANO RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4283
Mailing Address - Country:US
Mailing Address - Phone:520-906-7549
Mailing Address - Fax:
Practice Address - Street 1:3830 E BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4012
Practice Address - Country:US
Practice Address - Phone:520-323-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-27
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC # 11668101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)