Provider Demographics
NPI:1942329073
Name:GODDARD, LAURA KORKISS (LMFT, PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:KORKISS
Last Name:GODDARD
Suffix:
Gender:F
Credentials:LMFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18411 CRENSHAW BLVD STE 412
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5042
Mailing Address - Country:US
Mailing Address - Phone:310-308-5046
Mailing Address - Fax:
Practice Address - Street 1:18411 CRENSHAW BLVD STE 412
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5042
Practice Address - Country:US
Practice Address - Phone:310-308-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist