Provider Demographics
NPI:1720415169
Name:MYERS, LAURA KNOLL (MS)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KNOLL
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LOUISE
Other - Last Name:KNOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2305 CALLE LAUREL APT 409
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00913-4606
Mailing Address - Country:US
Mailing Address - Phone:619-933-6940
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:586-335-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76723106H00000X
CA89833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist