Provider Demographics
NPI:1881163426
Name:HILLER, LAUREL LYNN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:LYNN
Last Name:HILLER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11468 MARKETPLACE DR N STE 6001083
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3872
Mailing Address - Country:US
Mailing Address - Phone:763-310-1352
Mailing Address - Fax:
Practice Address - Street 1:11468 MARKETPLACE DR N STE 6001083
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3872
Practice Address - Country:US
Practice Address - Phone:763-310-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN645618OtherTRICARE
MN231284OtherU CARE