Provider Demographics
NPI:1881728913
Name:KRELL, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KRELL
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 1:337 S. BEVERLY DR.
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-625-8475
Mailing Address - Fax:
Practice Address - Street 1:337 S BEVERLY DR
Practice Address - Street 2:SUITE 208
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4315
Practice Address - Country:US
Practice Address - Phone:310-625-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist