Provider Demographics
NPI:1710083225
Name:SOUTHERN, LAURA JANE (LPCC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:SOUTHERN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 BUSCH BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2508
Mailing Address - Country:US
Mailing Address - Phone:614-595-8846
Mailing Address - Fax:866-863-3353
Practice Address - Street 1:6161 BUSCH BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2508
Practice Address - Country:US
Practice Address - Phone:614-595-8846
Practice Address - Fax:866-863-3353
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health