Provider Demographics
NPI:1710035415
Name:BREWER, LAURIE S (MFT)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:S
Last Name:BREWER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:S
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:3200 21ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3144
Mailing Address - Country:US
Mailing Address - Phone:661-395-1068
Mailing Address - Fax:661-395-0372
Practice Address - Street 1:3200 21ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3144
Practice Address - Country:US
Practice Address - Phone:661-395-1068
Practice Address - Fax:661-395-0372
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30542106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist