Provider Demographics
NPI:1427551076
Name:LAUGHLIN, CLARISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:LAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CZUPRYNSKI
Mailing Address - Street 1:19743 SUSQUEHANNA WAY
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-8051
Mailing Address - Country:US
Mailing Address - Phone:760-705-7257
Mailing Address - Fax:
Practice Address - Street 1:2131 S BONITO WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1659
Practice Address - Country:US
Practice Address - Phone:208-202-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA979611041C0700X
CA818581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical