Provider Demographics
NPI:1447677596
Name:CHURCHILL, LAURA L (MC, LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E APACHE ST
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2442
Mailing Address - Country:US
Mailing Address - Phone:928-668-4725
Mailing Address - Fax:928-668-4397
Practice Address - Street 1:1 E APACHE ST
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2442
Practice Address - Country:US
Practice Address - Phone:928-668-4725
Practice Address - Fax:928-668-4397
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC13946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional