Provider Demographics
NPI:1790311942
Name:KINGSLEY, LAURIE (LMFT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 ANACAPA ST STE 2I
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-7124
Mailing Address - Country:US
Mailing Address - Phone:805-722-4170
Mailing Address - Fax:
Practice Address - Street 1:924 ANACAPA ST STE 2I
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-7124
Practice Address - Country:US
Practice Address - Phone:805-722-4170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist