Provider Demographics
NPI:1750752663
Name:ALLIS, LAURA KRISTIN (MS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KRISTIN
Last Name:ALLIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11129 SEWARD PLZ APT 2009
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4856
Mailing Address - Country:US
Mailing Address - Phone:402-639-4332
Mailing Address - Fax:
Practice Address - Street 1:11129 SEWARD PLZ APT 2009
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4856
Practice Address - Country:US
Practice Address - Phone:402-639-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health