Provider Demographics
NPI:1457776445
Name:WILVERT, LAURA ANNE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANNE
Last Name:WILVERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:MAINWARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:793 E. FOOTHILL BLVD
Mailing Address - Street 2:SUITE A, #278
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405
Mailing Address - Country:US
Mailing Address - Phone:805-305-7284
Mailing Address - Fax:
Practice Address - Street 1:793 E. FOOTHILL BLVD
Practice Address - Street 2:SUITE A, #278
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405
Practice Address - Country:US
Practice Address - Phone:805-305-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101310106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist