Provider Demographics
NPI:1578750873
Name:EBRIGHT, LAURA MARIE
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:EBRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:SANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1428 SILVER PINE LN
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7926
Mailing Address - Country:US
Mailing Address - Phone:419-344-5055
Mailing Address - Fax:
Practice Address - Street 1:134 W SOUTH BOUNDARY ST
Practice Address - Street 2:SUITE MM
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1763
Practice Address - Country:US
Practice Address - Phone:419-873-0891
Practice Address - Fax:419-873-0892
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0602245101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor