Provider Demographics
NPI:1811558950
Name:STANLEY, LAURA DELEAN (CPSS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DELEAN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 REGAL ROW
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-6097
Mailing Address - Country:US
Mailing Address - Phone:985-791-8525
Mailing Address - Fax:
Practice Address - Street 1:158 REGAL ROW
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-6097
Practice Address - Country:US
Practice Address - Phone:985-791-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist