Provider Demographics
NPI:1699830406
Name:THEIS, LAURA A (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:THEIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 EAST COFFEE CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5806
Mailing Address - Country:US
Mailing Address - Phone:405-210-1356
Mailing Address - Fax:405-736-0840
Practice Address - Street 1:6003 N ROBINSON
Practice Address - Street 2:SUITE 107
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118
Practice Address - Country:US
Practice Address - Phone:405-210-1356
Practice Address - Fax:405-736-0840
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional