Provider Demographics
NPI:1710158894
Name:KING, LAURA LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LOUISE
Last Name:KING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HAMILTON AVE
Mailing Address - Street 2:SUITE 339
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2010
Mailing Address - Country:US
Mailing Address - Phone:650-554-0230
Mailing Address - Fax:
Practice Address - Street 1:550 HAMILTON AVE
Practice Address - Street 2:SUITE 339
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2010
Practice Address - Country:US
Practice Address - Phone:650-554-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24175103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist