Provider Demographics
NPI:1598186025
Name:PAULSON, LAURA JANE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JANE
Last Name:PAULSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W WASHINGTON AVE
Mailing Address - Street 2:APT. 518
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6583
Mailing Address - Country:US
Mailing Address - Phone:310-502-5497
Mailing Address - Fax:
Practice Address - Street 1:10833 WILSHIRE BLVD
Practice Address - Street 2:APT. 103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4380
Practice Address - Country:US
Practice Address - Phone:310-502-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist