Provider Demographics
NPI:1568983930
Name:LIVING PROOF LLC
Entity Type:Organization
Organization Name:LIVING PROOF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER-PSYCHIATRIC NP
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FPMH-NP, RXN
Authorized Official - Phone:303-912-0932
Mailing Address - Street 1:304 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2552
Mailing Address - Country:US
Mailing Address - Phone:303-912-0932
Mailing Address - Fax:719-937-2053
Practice Address - Street 1:309 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2534
Practice Address - Country:US
Practice Address - Phone:303-912-0932
Practice Address - Fax:719-937-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5376363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty