Provider Demographics
NPI:1922515741
Name:LAURELCARE OUTPATIENT THERAPY WEST, LLC
Entity Type:Organization
Organization Name:LAURELCARE OUTPATIENT THERAPY WEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:CORR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:412-779-3693
Mailing Address - Street 1:37 MCMURRAY RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 HATTMAN DR
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-3728
Practice Address - Country:US
Practice Address - Phone:412-353-9260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAUREL EQUITY HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty