Provider Demographics
NPI:1114645686
Name:JEWELL, LAURA BETH (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:JEWELL
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 CRESTLINE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-8133
Mailing Address - Country:US
Mailing Address - Phone:615-545-2194
Mailing Address - Fax:
Practice Address - Street 1:2702 CRESTLINE CT
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-8133
Practice Address - Country:US
Practice Address - Phone:615-545-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09741225A00000X
PAPC016281101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist