Provider Demographics
NPI:1578324315
Name:LAURA C KERESTLY
Entity Type:Organization
Organization Name:LAURA C KERESTLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KERESTLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-240-2899
Mailing Address - Street 1:27 CHERRY HILLS E
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5114
Mailing Address - Country:US
Mailing Address - Phone:616-240-2899
Mailing Address - Fax:
Practice Address - Street 1:542 HICKORY ST STE 109
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5002
Practice Address - Country:US
Practice Address - Phone:616-240-2899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty