Provider Demographics
NPI:1558418723
Name:FRENCH, LAURENCE A (PHD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:A
Last Name:FRENCH
Suffix:
Gender:M
Credentials:PHD
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 446
Mailing Address - Street 2:624 W. 8TH STREET
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85548-0446
Mailing Address - Country:US
Mailing Address - Phone:928-428-6554
Mailing Address - Fax:928-428-7266
Practice Address - Street 1:624 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2807
Practice Address - Country:US
Practice Address - Phone:928-428-6554
Practice Address - Fax:928-428-7266
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1795103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZPHD1795Medicare ID - Type Unspecified