Provider Demographics
NPI:1851819486
Name:BROTHERSON, LAURA M (LMFT, CST, CFLE)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:BROTHERSON
Suffix:
Gender:F
Credentials:LMFT, CST, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHERRY LANE COUNSELING CENTER
Mailing Address - Street 2:403 W. CHERRY LANE
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-887-1911
Mailing Address - Fax:
Practice Address - Street 1:CHERRY LANE COUNSELING CENTER 403 W. CHERRY LANE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-887-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist