Provider Demographics
NPI:1790297042
Name:CONDON, LAURA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CONDON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1167
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-1167
Mailing Address - Country:US
Mailing Address - Phone:800-745-3715
Mailing Address - Fax:800-745-3715
Practice Address - Street 1:625 S COBB ST STE 201
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6480
Practice Address - Country:US
Practice Address - Phone:907-355-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional