Provider Demographics
NPI:1295043222
Name:ORTMAN, LAURA D (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:D
Last Name:ORTMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 E THOUSAND OAKS BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6977
Mailing Address - Country:US
Mailing Address - Phone:818-650-2900
Mailing Address - Fax:
Practice Address - Street 1:4045 E THOUSAND OAKS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6977
Practice Address - Country:US
Practice Address - Phone:818-650-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81033106H00000X, 106H00000X
106H00000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner