Provider Demographics
NPI:1598229197
Name:LOCHBAUM, LAURA ALYSSA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ALYSSA
Last Name:LOCHBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1782 E BULLARD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5868
Mailing Address - Country:US
Mailing Address - Phone:559-515-6485
Mailing Address - Fax:
Practice Address - Street 1:1782 E BULLARD AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5868
Practice Address - Country:US
Practice Address - Phone:559-515-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician