Provider Demographics
NPI:1811262439
Name:BURLINGAME-LEE, LAURA JOAN (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JOAN
Last Name:BURLINGAME-LEE
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:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:
Practice Address - Street 1:3025 W CHERRY LN STE 204
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8530
Practice Address - Country:US
Practice Address - Phone:208-302-3300
Practice Address - Fax:208-302-3355
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID203095103T00000X
103TC1900X
IDPSY-203095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling