Provider Demographics
NPI:1598998361
Name:SEBELIA, LAURA GAIL (MS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:GAIL
Last Name:SEBELIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6821
Mailing Address - Country:US
Mailing Address - Phone:951-295-5813
Mailing Address - Fax:
Practice Address - Street 1:1585 S D ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3235
Practice Address - Country:US
Practice Address - Phone:909-388-2222
Practice Address - Fax:909-388-2220
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56438106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist