Provider Demographics
NPI:1750836185
Name:PUFFER, LAURA (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:PUFFER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15120 COUNTY BARN RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4263
Mailing Address - Country:US
Mailing Address - Phone:228-284-6062
Mailing Address - Fax:228-864-2614
Practice Address - Street 1:15120 COUNTY BARN RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4263
Practice Address - Country:US
Practice Address - Phone:228-284-6062
Practice Address - Fax:228-864-2614
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional