Provider Demographics
NPI:1184625493
Name:BIRHOLTZ, LAURA S (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:S
Last Name:BIRHOLTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 E TANGERINE RD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-6225
Mailing Address - Country:US
Mailing Address - Phone:520-270-0376
Mailing Address - Fax:
Practice Address - Street 1:1521 E TANGERINE RD
Practice Address - Street 2:SUITE 131
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6225
Practice Address - Country:US
Practice Address - Phone:520-270-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1426103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist