Provider Demographics
NPI:1922176353
Name:GATES, LAURA LEIGH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEIGH
Last Name:GATES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 DESERT CANYON RD
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-3360
Mailing Address - Country:US
Mailing Address - Phone:203-449-0972
Mailing Address - Fax:
Practice Address - Street 1:515 DESERT CANYON RD
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-3360
Practice Address - Country:US
Practice Address - Phone:203-449-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-129681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-12968OtherLCSW LICENSE