Provider Demographics
NPI:1497143945
Name:NUNEZ, LAURA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 44TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7187
Mailing Address - Country:US
Mailing Address - Phone:309-793-3460
Mailing Address - Fax:309-732-0551
Practice Address - Street 1:223 1 STREET
Practice Address - Street 2:
Practice Address - City:COLONA
Practice Address - State:IL
Practice Address - Zip Code:61241
Practice Address - Country:US
Practice Address - Phone:309-431-1555
Practice Address - Fax:855-515-0810
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist