Provider Demographics
NPI:1831676311
Name:LIM, LAURA KAYLA (LCSW, PPS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAYLA
Last Name:LIM
Suffix:
Gender:F
Credentials:LCSW, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12598 CENTRAL AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3530
Mailing Address - Country:US
Mailing Address - Phone:626-322-8729
Mailing Address - Fax:
Practice Address - Street 1:12598 CENTRAL AVE STE 205
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3530
Practice Address - Country:US
Practice Address - Phone:626-322-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical