Provider Demographics
NPI:1871085118
Name:LAURITZEN, JOSI MOON (LPC, LCDC)
Entity type:Individual
Prefix:MRS
First Name:JOSI
Middle Name:MOON
Last Name:LAURITZEN
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6917
Mailing Address - Country:US
Mailing Address - Phone:972-741-7548
Mailing Address - Fax:469-206-7227
Practice Address - Street 1:605 CLIFFSIDE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-6917
Practice Address - Country:US
Practice Address - Phone:972-741-7548
Practice Address - Fax:469-206-7227
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275984684OtherNPI