Provider Demographics
NPI:1710920194
Name:VANSICKLE, LAURA ANNE (LCP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANNE
Last Name:VANSICKLE
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:VANSICKLE-DEAVOURS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2615 PRAIRIE ELM DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 ROCKLEDGE ROAD
Practice Address - Street 2:CHRISTIAN PSYCHOLOGICAL SERVICES SUITE
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-843-2429
Practice Address - Fax:785-843-7386
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCP321101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor