Provider Demographics
NPI:1245260009
Name:CLARK, LAURA AYALA (LMFT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:AYALA
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LONG CT STE C
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6065
Mailing Address - Country:US
Mailing Address - Phone:805-379-8765
Mailing Address - Fax:805-493-1231
Practice Address - Street 1:88 LONG CT STE C
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6065
Practice Address - Country:US
Practice Address - Phone:805-379-8765
Practice Address - Fax:805-493-1231
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28962106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist