Provider Demographics
NPI:1023112182
Name:LEISTER, LAURA K (MS LLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:LEISTER
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 HEMPHILL ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3077
Mailing Address - Country:US
Mailing Address - Phone:734-646-0388
Mailing Address - Fax:734-241-6552
Practice Address - Street 1:2750 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6179
Practice Address - Country:US
Practice Address - Phone:734-662-6300
Practice Address - Fax:734-662-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011320103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist