Provider Demographics
NPI:1710990254
Name:GOMEZ-WEAKLEY, LAURA (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GOMEZ-WEAKLEY
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 1:8169 S CORONA WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2932
Mailing Address - Country:US
Mailing Address - Phone:303-916-8847
Mailing Address - Fax:720-283-4101
Practice Address - Street 1:7800 S ELATI ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4483
Practice Address - Country:US
Practice Address - Phone:303-916-8847
Practice Address - Fax:720-283-4101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health