Provider Demographics
NPI:1184786675
Name:PHEN, LAURA A (EDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:PHEN
Suffix:
Gender:
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N OBERG CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-0313
Mailing Address - Country:US
Mailing Address - Phone:402-508-6263
Mailing Address - Fax:
Practice Address - Street 1:1801 N OBERG CIR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-0313
Practice Address - Country:US
Practice Address - Phone:402-508-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1743101YM0800X
SDLPC-MH2170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health