Provider Demographics
NPI:1497148159
Name:FORSBLAD, LAURA ANNE (LCMHC, LMHC, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:FORSBLAD
Suffix:
Gender:F
Credentials:LCMHC, LMHC, LCPC
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:BEAUDOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC, LMHC
Mailing Address - Street 1:1 MIDDLE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 MIDDLE ST STE 205
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4391
Practice Address - Country:US
Practice Address - Phone:978-548-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC9634101YA0400X
NHLCMHC2095101YA0400X
MA9634101YM0800X
NH2095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty