Provider Demographics
NPI:1457199283
Name:NEJAD, LAURA BREANN (MS, PCLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BREANN
Last Name:NEJAD
Suffix:
Gender:F
Credentials:MS, PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 INGOMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3661
Mailing Address - Country:US
Mailing Address - Phone:406-425-4147
Mailing Address - Fax:
Practice Address - Street 1:1377 SPOONER RD UNIT A
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3114
Practice Address - Country:US
Practice Address - Phone:406-600-5907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-48957101YM0800X
MTBBH-LCPC-LIC-72519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health