Provider Demographics
NPI:1568939148
Name:TRESHNELL, LAUDENE N
Entity Type:Individual
Prefix:
First Name:LAUDENE
Middle Name:N
Last Name:TRESHNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 EUCALYPTUS KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2258
Mailing Address - Country:US
Mailing Address - Phone:415-246-1211
Mailing Address - Fax:
Practice Address - Street 1:311 MILLER AVE STE M
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2897
Practice Address - Country:US
Practice Address - Phone:415-246-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38281OtherINDIVIDUAL THERAPIST