Provider Demographics
NPI:1568050797
Name:SPILLIS, LAURA ANN (MS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:SPILLIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 S EASY ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-5022
Mailing Address - Country:US
Mailing Address - Phone:786-661-0661
Mailing Address - Fax:
Practice Address - Street 1:726 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5442
Practice Address - Country:US
Practice Address - Phone:772-257-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health