Provider Demographics
NPI:1902971401
Name:HAUSE, LAUREL ANN (LPCC)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:HAUSE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:DBA LAURIE
Other - Middle Name:
Other - Last Name:HAUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:2811 INDIAN SCHOOL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1825
Mailing Address - Country:US
Mailing Address - Phone:505-243-1158
Mailing Address - Fax:505-243-2115
Practice Address - Street 1:2811 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1825
Practice Address - Country:US
Practice Address - Phone:505-243-1158
Practice Address - Fax:505-243-2115
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54109361Medicaid