Provider Demographics
NPI:1447449038
Name:KEMP, LAURA MARIE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:KEMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15904 CHEHALIS CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-6259
Mailing Address - Country:US
Mailing Address - Phone:760-686-4968
Mailing Address - Fax:
Practice Address - Street 1:15904 CHEHALIS CT
Practice Address - Street 2:SUITE B
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-6259
Practice Address - Country:US
Practice Address - Phone:760-686-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)