Provider Demographics
NPI:1801187257
Name:STEVENS, LAURA JEAN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:STEVENS
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 1:714 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4906
Mailing Address - Country:US
Mailing Address - Phone:218-205-0535
Mailing Address - Fax:218-728-7195
Practice Address - Street 1:714 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4906
Practice Address - Country:US
Practice Address - Phone:218-205-0535
Practice Address - Fax:218-728-7195
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist