Provider Demographics
NPI:1669132973
Name:LAUREL THERAPY COLLECTIVE, INC, A LICENSED MARRIAGE AND FAMILY THERAPY
Entity type:Organization
Organization Name:LAUREL THERAPY COLLECTIVE, INC, A LICENSED MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ROBERTS-MEESE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-504-2895
Mailing Address - Street 1:2355 WESTWOOD BLVD # 549
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2109
Mailing Address - Country:US
Mailing Address - Phone:415-504-2895
Mailing Address - Fax:
Practice Address - Street 1:1756 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-504-2895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty