Provider Demographics
NPI:1659393676
Name:TEMPLET, LAURA GUSSEN (LSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:GUSSEN
Last Name:TEMPLET
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402
Mailing Address - Country:US
Mailing Address - Phone:970-249-9694
Mailing Address - Fax:970-249-2955
Practice Address - Street 1:195 STAFFORD LN
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416
Practice Address - Country:US
Practice Address - Phone:970-874-8981
Practice Address - Fax:970-874-8989
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical