Provider Demographics
NPI:1518028315
Name:LAURES, JOHN TERRY (LADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TERRY
Last Name:LAURES
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20333 CTY RD #2
Mailing Address - Street 2:
Mailing Address - City:CHATFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55923
Mailing Address - Country:US
Mailing Address - Phone:507-287-2099
Mailing Address - Fax:507-287-2274
Practice Address - Street 1:47 13 1/2 ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3519
Practice Address - Country:US
Practice Address - Phone:507-287-2099
Practice Address - Fax:507-287-2274
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300417101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)