Provider Demographics
NPI:1770051401
Name:TOWNSEND, LAURA LEE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30200 RANCHO VIEJO RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1560
Mailing Address - Country:US
Mailing Address - Phone:949-373-5890
Mailing Address - Fax:
Practice Address - Street 1:30200 RANCHO VIEJO RD STE D
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1560
Practice Address - Country:US
Practice Address - Phone:949-373-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5784101YP2500X
CA110139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional