Provider Demographics
NPI:1912367160
Name:LAUREL COUNSELING & CONSULTATION SERVICES
Entity Type:Organization
Organization Name:LAUREL COUNSELING & CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, DMIN, BCC
Authorized Official - Phone:619-944-8293
Mailing Address - Street 1:138 CIVIC CENTER DR STE 116
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6041
Mailing Address - Country:US
Mailing Address - Phone:619-944-8293
Mailing Address - Fax:
Practice Address - Street 1:138 CIVIC CENTER DR STE 116
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6041
Practice Address - Country:US
Practice Address - Phone:619-944-8293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT86487251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTRIWEST