Provider Demographics
NPI:1578839742
Name:CARTER, LAURA JACOBSEN (MHC/ LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JACOBSEN
Last Name:CARTER
Suffix:
Gender:F
Credentials:MHC/ LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 1200 S
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-3211
Mailing Address - Country:US
Mailing Address - Phone:801-465-6909
Mailing Address - Fax:
Practice Address - Street 1:1835 N 1120 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1180
Practice Address - Country:US
Practice Address - Phone:801-477-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8161058-6009251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health