Provider Demographics
NPI:1720120827
Name:YABLICK, LAURI MICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:MICHELLE
Last Name:YABLICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7461 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3477
Mailing Address - Country:US
Mailing Address - Phone:520-320-6230
Mailing Address - Fax:520-322-3665
Practice Address - Street 1:2650 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6106
Practice Address - Country:US
Practice Address - Phone:520-320-6230
Practice Address - Fax:520-322-3665
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1975103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0616740OtherBLUE CROSS BLUE SHIELD AZ
AZ104779Medicaid
AZZ121218Medicare PIN
AZR09470Medicare UPIN