Provider Demographics
NPI:1437280070
Name:REED, LAURA LYNN (MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:REED
Suffix:
Gender:F
Credentials:MA
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 52
Mailing Address - Street 2:
Mailing Address - City:FOREST FALLS
Mailing Address - State:CA
Mailing Address - Zip Code:92339-0052
Mailing Address - Country:US
Mailing Address - Phone:909-836-7314
Mailing Address - Fax:
Practice Address - Street 1:9408 MILL DR FOREST FALLS
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:92339
Practice Address - Country:US
Practice Address - Phone:323-798-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF49619106H00000X
CAMFC45650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225400000XOtherREHABILITATION PRACTIONER
CAMFC45650OtherBBS