Provider Demographics
NPI:1659555423
Name:HADDOCK, LAURA R (PHD, LPC, ACS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:R
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:PHD, LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 OAKLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7648
Mailing Address - Country:US
Mailing Address - Phone:662-902-4710
Mailing Address - Fax:
Practice Address - Street 1:3100 OAKLEIGH LN
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7648
Practice Address - Country:US
Practice Address - Phone:662-902-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSIMPLAUROtherCORPHEALTH, INC