Provider Demographics
NPI:1780920173
Name:MITCHELL, LAURA HOUGH (MFT, PHD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:HOUGH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-3812
Mailing Address - Country:US
Mailing Address - Phone:760-745-9819
Mailing Address - Fax:
Practice Address - Street 1:2842 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-3812
Practice Address - Country:US
Practice Address - Phone:760-745-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29158106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist