Provider Demographics
NPI:1871617134
Name:FERRELL, LAURA JILL (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JILL
Last Name:FERRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2031
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2031
Mailing Address - Country:US
Mailing Address - Phone:505-890-0444
Mailing Address - Fax:
Practice Address - Street 1:4686 CORRALES RD
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8610
Practice Address - Country:US
Practice Address - Phone:505-890-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM704103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG7268Medicaid
NMG7268Medicaid