Provider Demographics
NPI:1831676311
Name:LIM, LAURA KAYLA (LCSW, PPSC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KAYLA
Last Name:LIM
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5218 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CA
Mailing Address - Zip Code:90058-3518
Mailing Address - Country:US
Mailing Address - Phone:626-322-8729
Mailing Address - Fax:
Practice Address - Street 1:5218 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CA
Practice Address - Zip Code:90058-3518
Practice Address - Country:US
Practice Address - Phone:626-322-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical