Provider Demographics
NPI:1245063155
Name:TONCRAY, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TONCRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BABAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3716 W BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2938
Mailing Address - Country:US
Mailing Address - Phone:309-692-7755
Mailing Address - Fax:309-692-2262
Practice Address - Street 1:3716 W BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2938
Practice Address - Country:US
Practice Address - Phone:309-692-7755
Practice Address - Fax:309-692-2262
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional