Provider Demographics
NPI:1689267981
Name:ALLEN, LAURA (EDS)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:HERNANDEZ-ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDS
Mailing Address - Street 1:9040 N PLACITA VERDE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-8334
Mailing Address - Country:US
Mailing Address - Phone:618-960-9141
Mailing Address - Fax:
Practice Address - Street 1:9040 N PLACITA VERDE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-8334
Practice Address - Country:US
Practice Address - Phone:618-960-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1578727103TS0200X
AZ5287668103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty