Provider Demographics
NPI:1659475168
Name:MORRISON, LAURA SKILLERN (PHD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SKILLERN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SKILLERN
Other - Last Name:MCWETHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:GRAEAGLE
Mailing Address - State:CA
Mailing Address - Zip Code:96103-0979
Mailing Address - Country:US
Mailing Address - Phone:530-836-1800
Mailing Address - Fax:530-836-0472
Practice Address - Street 1:7597 HIGHWAY 89
Practice Address - Street 2:SUITE 4
Practice Address - City:GRAEAGLE
Practice Address - State:CA
Practice Address - Zip Code:96103-0979
Practice Address - Country:US
Practice Address - Phone:530-836-1800
Practice Address - Fax:530-836-0472
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA284604OtherVALUE OPTIONS
CA284604OtherVALUE OPTIONS